Sergey Nivens - Fotolia
ORLANDO -- Healthcare in the U.S. is transforming faster than it has in generations, and almost none of the changes -- including those affecting financial performance -- can happen without health IT.
Providers must balance clinical and business reforms, such as those illustrated by the so-called Triple Aim framework, which calls for a three-pronged transformation:
- Reduce the per capita cost of healthcare
- Improve population health efforts
- Improve the patient care experience, including quality and satisfaction
Developed by the Institute for Healthcare Improvement in Cambridge, Mass., the Triple Aim framework is far more than a lofty trio of goals. Federal and state governments, along with health insurance companies, are incentivizing healthcare providers to adopt it and penalizing them when they don't.
The Triple Aim framework was on the minds of more than 2,000 healthcare revenue cycle professionals who gathered in Orlando, Fla., in June to attend the Healthcare Financial Management Association's (HFMA) annual conference. What became evident over the HFMA's National Institute (ANI for short) is that without a robust healthcare IT infrastructure, it will be nigh impossible to accomplish the Triple Aim. And healthcare financial executives know it.
Survey: No cuts to health IT
At the outset of the ANI conference, HFMA released a report, "Strategies for Reconfiguring Cost Structure," that presented the results of a survey of almost 150 chief financial officers and healthcare finance executives across the country. The survey found that the majority of respondents' organizations will invest in IT, specifically data warehousing and reporting.
Melinda Hancocknational chair of HFMA
Furthermore, more than three-quarters of the respondents said they expected IT will see increased investment, a figure well above all other cost centers, such as physician organizations, equipment, facilities, clinical staff/services or administrative staff and services.
Expect hospitals to spend money not only on hot-button concerns, such as ICD-10 computer assisted coding tools and EHR systems, but also on data warehousing and predictive analytics to support initiatives around the Triple Aim framework.
If the Triple Aim has set its sights on anything, it's abolishing the fee-for-service healthcare model. "The fee-for-service payment system is diminishing," Melinda Hancock announced to the HFMA membership. Hancock, a partner in national consulting firm DHG Healthcare and the former CFO at Bon Secours Virginia Health System, is the new national chair of HFMA. While the American health system was built on volume, "it hasn't delivered the results commensurate with the resources put into it," she said.
This theme proved persistent and pervasive throughout the conference. In the future, healthcare payment models will focus on patient outcomes and other quality measures. Leading the charge is the federal government. CMS has established targets in this regard:
- Eighty-five percent of all Medicare fee-for-service payments will tie to quality or value by next year.
- Thirty percent of all payments will tie to alternative payment models, such as accountable care organizations (ACOs) and bundled-payment arrangements.
Hancock's charge to her fellow healthcare financial professionals was, in fact, a call out to IT: "We need dashboards that integrate financial and quality aspects," said Hancock. "Keep working on financial tools that manage revenue in volume and value and how to optimize both."
Where IT becomes more critical is in predictive analytics to help provider organizations manage risk. ACOs and other bundled payment financial models shift risk from the payer to the provider.
How big is that risk? Healthcare consultant and author Ian Morrison quoted a Kaiser Family Foundation analysis of federal data found that 1% of all patients consume 23% of all healthcare spending. If you imagine healthcare as a giant pie, one person out of 100 gets to eat a full quarter of the pie. Interestingly, 50 out of 100 eat very little of the pie (2.7%) at all.
Or as Charles Saunders, M.D., CEO of Healthagen (Aetna Inc.'s population health company), put it during one ANI session, "Being wrong on pricing can have massive losses." If a provider underestimates the volume of chronically ill patients, the losses from treating unanticipated numbers of chronically ill individuals can destroy the financial foundation of the healthcare organization.
Therefore it is up to IT to provide tools to measure and monitor risk, just as payer organizations have done for years. "You have to start thinking like a health plan," Saunders told the healthcare financial professionals.
Supporting population health
At a high level, it will fall to IT to provide the tools to enable providers to have an end-to-end focus on population health management, which, according to Saunders, means to:
- Aggregate and analyze clinical and financial data
- Organize and optimize the healthcare delivery system
- Manage high cost patients
- Identify and reduce risk factors
- Engage individuals
- Align incentives so rewards are based on value, not volume
At the heart of all these population health business processes is data, Saunders said. Data drives workflows, whether with patient engagement through personal devices or managing care coordination via internal communication. Also, data for analysis and business intelligence creates predictive analytics or smart workflows that provide real-time notifications to clinical staff when patients under their care have a health crisis, such as a visit to emergency room.
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