The Massachusetts Health Data Consortium‘s February 3 HIT’12: The Future is Now attracted leaders in healthcare from all over New England: providers, health plans, government agency staff, and other healthcare continuum stakeholders. This one-day event included such topics as "Cutting-Edge Technologies in Genomics, Robotics, and Medical Care," "How HIT Has Transformed Care Delivery," and "The Leading Challenges of 2012."
What if you could transform the terabytes of structured and unstructured medical data into actionable intelligence that physicians can use to meaningfully improve patient outcomes and satisfaction, as well as lower costs? This was the challenge addressed in the panel discussion “Technology Solutions to Meet the Challenges of the Future,” which included NaviNet’s own chief medical officer S. Michael Ross, MD, MHA, as well as moderator Jim Noga, CP and CIO, Partners HealthCare, and panelists Greg DeBor, Managing Director, Health Solutions, at Manatt, Phelps & Phillips LLP, and Paul Grabscheid, VP of Strategic Planning at InterSystems.
Don’t Boil the Ocean
Critical care gaps, patient-centered medical homes (PCMHs), care collaboration, and the analytics to support value-based medical functions were the heart of the conversation. According to Greg DeBor, health information exchanges (HIEs) are a good first step, but they are not sufficient: Identifying the gaps in the coordination of care presents opportunities to deliver better care in a collaborative and cost-effective way. Greg highlighted that the focus needs to be on how to use the technology in a meaningful way—and how an organization handles all of the business requirements and change processes implicit in the move to accountable care. The value isn’t just in the exchange of data, but in the management, command, and structuring of the master data—the metadata.
Greg likened what we need in healthcare to a credit card fraud department, which is effective in certifying people and has standards in protecting data and ensuring that when a problem arises, the right person will be immediately notified. Similarly, patients want to know that the ACO is there taking care of them. Data delivered in models like ACOs and PCMHs are all means to efficiencies and managing risk—and are building blocks supporting coordinated care. Greg’s advice: Don’t boil the ocean. Determine which use cases are most important and will provide value in a business sense—building revenue, increasing patient safety, and ensuring compliance.
Medical Home is an Answer
Paul Grabscheid opened his remarks citing a recently published Commonwealth Fund international survey that found people enrolled in a medical home experienced fewer gaps in care and were happier with their care that those not participating in a medical home. Troubling is that 22% of people surveyed in the U.S. experienced medical error. The push for the medical home model is a worldwide endeavor because the results indicate in general that more engaged patients have better outcomes.
Data exchange is important, but healthcare industry stakeholders have to be able to aggregate data in a meaningful way so that all members of the continuum can act on the data. Paul stated that his focus is on two main areas that his team is using new technologies to address:
(1) More analytic ability to be able to extract meaning from data.
(2) Trying to do a better job with the huge amount of textual data—about 90-95% of medical data is in text format.
What is the business case for HIE? How do we motivate the provider to pay for it? The economics appear to speak for themselves:
$2 Cost to Operate an HIE Per Person Per Year (Hardware, Software, Network, Operations)
$8,402 Per-Capita Health Expenditures (2010)
The Endangered into Phoenixes
Ever provocative, NaviNet’s Dr. Mike Ross opened with an eye-opening statement from Ezekiel J. Emanuel, “By 2020, the American health insurance industry will be extinct.” Dr. Ross immediately followed up with the challenge, “What if the right healthcare technology solution could change that prediction…now?”
He pointed out that health plans have claims-derived clinical information—like care gaps—that can positively impact the cost and quality of care when delivered through a patient’s own physician, the most trusted resource, at the most teachable and actionable moment of care. Health plans can provide a view into clinical blind spots helping physicians deliver better patient care while also helping them achieve superior performance metrics and enhanced remuneration. Providing patients with quality care takes a team effort, as well as the right tools to help manage that team and the information they share. Health plans can play a role on both counts.
Collaborative care is optimized through the sharing of administrative, financial, and clinical data. This functionality enables providers, care coordinators, and healthcare professionals to better manage quality and proactively improve chronic and preventive care across a population. Through their sponsorship of a care collaboration platform that reconciles claims and electronic health record- (EHR-) derived data, health plans will be able to intelligently deliver clinical decision support into the clinician workflow in the same way they’ve historically ported administrative and financial data to front- and-back office staff in the practices. As these platforms expand their functionality to embrace clinical data sets, physicians and health plans can enjoy the benefits of access to bidirectional unified patient information management (UPIM) to enable improved efficiency, efficacy, and quality.
Senior Director, Corporate Marketing
 2011 Survey of Patients with Complex Care Needs in Eleven Countries Finds That Care Is Often Poorly Coordinated, Cathy Schoen, M.S., Robin Osborn, M.B.A., David Squires, M.A., Michelle M. Doty, Ph.D., Roz Pierson, Ph.D., and Sandra Applebaum, M.S., Commonwealth Fund, November 9, 2011.
 “The End of Insurance Companies,” Ezekiel J. Emanuel, The New York Times, January 30, 2012.