Janice McCallum, Managing Director of Health Content Advisors, is a leading blogger and contributor to healthcare IT conversations on social media. We spoke with Janice about HIT developments, Big Data, the progress of the accountable care organization model, and other issues impacting the delivery of health carein 2013.
What do you see as the biggest developments for HIT in the next year?
I think the biggest developments will occur as provider organizations build upon the population health analysis that got its start with the foundation laid by the Meaningful Use framework. In particular, we’ll see more analyses of treatment plans, costs,and outcomes by segments of patients. The segmentation possibilities are almost endless. When combined with genomic data and other nontraditional types of data, they will bring us a long way toward the goal of personalized medicine.
There’s been so much talk around big data for a variety of industries, but what does it mean for the healthcare industry?
Big Data can mean different things to different audiences. Recently, I gave a talk where I offered several definitions of the term.1 To begin, I define Big Data very broadly as “advanced analytics for complex problem solving” and believe that the value of Big Data lies in unlocking patterns and insights that would not have been possible without the combination of computing power, analytic tools, and diverse data sets that constitute Big Data. So, to offer a perhaps overly simplified answer, Big Data can help medical researchers, clinicians, industry analysts, payers and patients—in fact all stakeholders—better understand the relationships between health, disease, and treatments.
In my Big Data presentation, I illustrate a model where the evidence base we use in determining care options is constantly updated with new data from patient records, research registries, and other studies. The ideal would be a system that incorporates new data that either reinforces or replaces currently accepted knowledge.
However, to benefit from many of the existing Big Data technologies and modeling that are being used in retail, financial services, and other industries, the health care industry needs to improve the amount of collaboration at the level of sharing data sets and sharing results from previous analyses. Obviously, there are some limitations on how patient registries can be shared, but there is good progress in creating large research datasets that include de-identified patient data. In fact, the Agency for Healthcare and Quality recently released a registry of patient registries (RoPR).2
Last year you identified the accountable care organization (ACO) model as one of the major factors to shape care collaboration. How much of that has happened, and how much further do we need to go?
There has been good progress in establishing ACOs, with 32 “pioneer” ACOs3 created as of January 2013. However, I think most of these ACOs have just scratched the surface in establishing a new model of providing care and involving patients in decisions about their care. It will take some time for the culture of physician-patient communication to change. Furthermore, the tools that have been available to educate and support clinicians and patients haven’t kept up with the organizational changes. In particular, patient education/patient information tools and materials are sorely lacking for patients who want to take a more active role in their health and medical care. I cringe every time I hear that patient education materials have to be prepared to meet the reading level of the “lowest common denominator” in the spectrum of patients. While I understand that some public health messages must be understandable to a very broad spectrum of the population, the same rationale doesn’t apply to all information made available to patients.
What are some of the key components that a HIT platform needs in order to be successfulin today’s changing healthcare landscape?
There are other people who could answer this question with a higher level of specificity than I can. That said, an enormously important component of an HIT platform is the ability to import data from other sources into the system and to export or share access to records (or parts of records) with other systems. The other systems may be within the same hospital group/ACO or with other providers, researchers, payers, and, of course, patients. In fact, ACOs and the so-called patient-centered medical home (PCMH) concept should put a high priority on configuring their systems so that patients can both contribute information and download information from their records. This way patients can act as their ownup-to-date “mobile record.” Not all patients are ready to take on this role, but that’s not a good reason to prevent those patients who are ready from improving access to information that can improve the quality of care they receive and possibly reduce the cost. The early innovators among the patient populations who actively track, update, and analyze their personal health records can serve as models for the “laggards” who will wait until the benefits become more obvious and the tools become easier to use.
The Accountable Care Act (ACA)will soon be implemented, and millions of newly insured Americans will be receiving care that did not previously. How are payers planning to handle this?
Apart from having designed new plans that are ready to be promoted and sold on health insurance exchanges (now called health insurance marketplaces4), I can only make an educated guess on how payers are planning to handle the new populations of patients who will be insured as a result of the ACA. Note, I have a different view on how much the newly insured will increase the demand for medical services, compared with the conventional wisdom,whichestimates that the previously uninsured will flood primary care physicians with pent-up need for medical care. I agree that physician practices will enroll many new patients in areas where there had been a large number of uninsured. However, I think that a large number of the newly insured patients will have so much experience managing their own care that they won’t overburden the provider organizations as much as some analysts predict. Plus, many of the insurance plans available to these populations will include significant co-pays (significant is in the eye of the beholder in this case!). With high co-pays, I predict that populations that were unable to afford insurance coverage in the past will not be able to afford most co-pays and will find ways to reduce their costs of care whenever possible by using retail clinics and other lower-cost options, such as telehealth.
The medical cost trend has slowed considerably in the past few years. What can providers and payers do to help keep costs from rising?
The best advice I have to keep costs from rising is to provide more information about costs to patients before they choose a course of treatment. Providing more information about the likely benefits and risks of treatment plan options under consideration to patients will also increase the patient’s level of commitment to the chosen treatment plan. Moving to this “shared decision-making” model will likely reduce costs in the short term, although that’s not a sure bet, since cost is not the only criterion that patients will consider.
As I consider the topics we’ve just discussed, it occurs to me that the most significant move that payers could make to slow the rise in costs would be to simplify health insurance plans so that costs are far more transparent. Some payers are ahead of others in offering data on costs. For instance, Aetna offers an average estimated cost by region in its Aetna Navigator tool5. Although not complete, Aetna’s move in the direction of providing cost information is a step in the right direction.
Thank you, Janice, for your insights on the opportunities and challenges facing healthcare stakeholders. We look forward to seeing you at dinner on Tuesday at HIMSSI13. What HIT issues and challenges are on your radar for 2013? Share your thoughts on our blog or by connecting with us on Twitter, Facebook, and LinkedIn.
Senior Director, Corporate Marketing
1 Big Data: Helping Scholarly Publishers Cut Through the Hype; Janice McCallum, Health Content Advisors at Association of American Publishers, 2013 PSP Annual Conference, February 7, 2013. http://www.slideshare.net/janicemc/j-mc-callumbig-datapsp2013
2 Agency for Healthcare Research and Quality, Registry of Patient Registries (RoPR) Abstract, December 4, 2012.
3 EHR Intelligence White Paper, Complete Directory of Accountable Care Organizations (ACOs), updated January 24, 2013. [registration required] http://ehrintelligence.com/2012/07/17/complete-directory-of-accountable-care-organizations-aco/
4 About Health Insurance Marketplaces, http://www.healthcare.gov/marketplace/about/index.html
5 Find Information On Health Care Costs, http://www.aetna.com/showcase/cost/know.html