The Center and its partners -- GE Healthcare, IBM, Lenovo Health, Nokia, and UPMC -- represent various facets of the health information technology community and serve as global thought leaders on subjects vital to the evolving health system: access to care, improving outcomes, infrastructure and efficiencies, consumerism, and data.
Confronting Challenges and Harnessing the Internet of Medical Things for Value-based Care
Access to Care
Patients should be able to readily obtain medical services and information, and providers should have access to the most up-to-date information about their patients. Access to care is a complex, multi-faceted and incredibly important factor in overall population health—especially preventative care. Access to care is affected by provider supply and health care information technology capabilities, payer plans and even government policy. Affordability, availability, accessibility, accommodation and acceptability all factor into and influence access to care.
Technology is improving access to care through virtual health care, smart home health, connected medicine and care coordination.
Virtual Health Care
The increasingly widespread adoption of telemedicine means many physicians and specialists no longer need to be physically located within a close geographic range for patients to benefit from their services and expertise. HIMSS Analytics estimates that 51 percent to 53 percent — or 2,900 to 3,000 — of U.S. hospitals will have installed telemedicine technology by 2020.
- Video visit interactions bring patients and providers face-to-face virtually.
- Native apps put consumers in touch with providers in just a few clicks.
- Smart phone photography and videography capabilities make sharing visuals simple.
Smart Home Health
Remote care management platforms operate by connecting a smart phone or tablet through Blue Tooth technology to devices such as monitors, sensors or scales; the connected device sends data and alerts to an application on the phone or tablet, which is then accessible to care providers. Remote care management gives providers greater visibility into patient health, which can help them catch health challenges before they escalate, allowing for early remediation and potentially preventing hospitalization.
Ubiquitous care extends beyond the home to include support for on-the-go consumers. Convenient care and applications that consumers take with them wherever they go include wearables linked to mobile apps.
- Health care mobile apps are introducing new avenues to care. For example, a particular app-based program in cognitive behavioral therapy is equal to or better than traditional in-person therapy, yet easier and more convenient to access. A dearth in psychiatrists and mental health support in the U.S. heightens the significance of such an application.
- Common wearables already track activity, heart rate, sleep and many other attributes; the next and rapidly approaching frontier will be for wearables that non-invasively track biometric vitals, such as glucose levels, to hit the mainstream marketplace.
- 165,000 health-related apps were available for Apple or Android smartphones in 2016. According to PricewaterhouseCoopers, it is predicted that those apps will have been downloaded 1.7 billion times by 2017.
Integration—easy, appropriate, even automated information-sharing—remains a tremendous challenge in health care. Improved integration and care coordination have the potential to influence access to care in these ways:
- Reduce fragmentation: Integration makes information-sharing among trusted sources, such as primary care physicians and specialists, easier. Better information-sharing prevents fragmented care and lowers costs by avoiding duplication, such as unnecessary labs or scans.
- Close the loop: Oftentimes, when a primary care physician (PCP) recommends that a patient see a specialist, the PCP has no way of knowing whether the patient followed through with the recommended treatment. This can be problematic for patient health.
- Reducing errors: Improved care coordination can help reduce medical errors by eliminating duplication of services, unnecessary tests and negative drug interactions.
- New support channels: Health care organizations are using new tools and determining new ways to help patients adhere to treatment paths. For example, predictive analytics is being used to improve medication adherence.
To realize improved outcomes, a connected and coordinated health system must empower clinicians to provide high-quality care in any setting. Along with lowering costs and giving patients a better experience, improving outcomes is key to achieving the shift to a value-based health system. While Americans pay more for health care than most other industrialized nations, health outcomes in the U.S., such as life expectancy and infant mortality, rank at the bottom compared to those same countries, according to the Organization for Economic Corporation and Development.
“Despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions.” – The Commonwealth Fund New technologies and payment models are driving the U.S. health system toward better results for patients and higher value.
Value-based Payment Models
Providers should be paid based on the quality of the care they deliver, not for the quantity of procedures they perform. The Centers for Medicare & Medicaid Services (CMS) is leading the charge in shifting from quantity to quality through Alternative Payment Models. Under the initiative, CMS is moving half of all traditional fee-for-service payments under Medicare to value-based payments by 2018.
In 2016, CMS said it had shifted $117 billion of Medicare’s $380 billion in fee-for-service payments to Alternative Payment Models the previous year. At the same time, CMS also said those value-based programs had generated $411 million in savings by reducing hospital-acquired infections, lowering readmission rates and other initiatives.
Some of the most important models, legislation and concepts steering health care toward value-based payment include:
- Bundled Payments: Bundled payment models incentivize health care providers to improve continuity, coordination, and outcomes. This approach pays providers for an entire episode of care instead of for each individual procedure.
- MACRA: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) seeks to reduce administrative burden on physicians, increase care efficiency and deliver improved patient health. MACRA is a driver behind value-based payment models, as it links physician payments to value.
- ACO: Accountable care organizations are groups of doctors, hospitals and other health care providers who come together to coordinate high quality, efficient care through communication and collaboration. The result may mean a patient spends less time filling out medical history paper work or avoids duplicative tests.
A number of new digital health tools have emerged in recent years that harness data analytics, electronic health records and other technologies with the aim of helping clinicians improve outcomes for patients. Several of these tools include:
- Clinical Decision Support: Clinical decision support (CDS) tools and software are designed to guide and enhance clinical decision-making. A Markets to Markets report predicts the CDS market will be worth more than $1.5 billion by 2021. Artificial intelligence, analytics, machine learning and cloud technologies are just some of the technologies creating new opportunities in CDS.
- Medication Adherence: Many patients fail to adhere to regimes for prescription medications, such as by missing dosages, splitting doses to make a prescription last longer or never filling a doctor’s prescription. This problem can lead to medical complications for patients and preventable hospitalizations. It’s estimated that $317 billion in annual costs could be saved if all patients followed their doctor’s prescription orders. Many technologies are being developed to better track medication adherence and engage patients.
- Precision Medicine and Genomics: Precision medicine is a strategy for providing medical care tailored to specific patient populations, or for individuals based on their genetics. Health systems are pursuing precision medicine and genomics in value-based care because they can allow clinicians to bypass ineffective treatments and ultimately save money. Big data analytics and artificial intelligence are being employed to in software applications to identify opportunities to tailor treatments.
Infrastructure and Efficiencies
As the health care system works toward the Triple Aim of lowering costs, boosting quality and improving patient satisfaction, many unseen but vital operational and financial functions must be improved. The future of health care demands that services be delivered using fewer resources. Harnessing data, using new digital tools and promoting integration are key factors.
New technologies are bringing greater efficiencies to health care infrastructure and operations, including bringing data analysis to hospital supply chains and using natural language processing to more accurately capture data from medical records.
Ultimately, improving operational and financial infrastructure and creating efficiencies in health care can lower costs for providers, payers and patients.
At the heart of providing greater value in health care is the need to make financial operations more efficient. A range of technologies are aiding health systems to achieve greater control over their finances:
- IDFS: An integrated delivery and finance system (IDFS) is a health care organization that offers a full spectrum of medical services and health plans to its patients. Integration and coordination of services and payments are a key feature of the IDFS model, which allow the health system to improve care and reduce costs.
- Revenue Cycle Management: Revenue cycle management (RCM) is an essential function in the efficient management of health system finances. RCM must work well for providers, payers, government and consumer audiences all the while keeping pace with shifting payment models. In 2016, roughly one-quarter of health care payments stemmed from an alternative payment model, such as a value-based payment model. But providers expect half of their revenue to be from value-based contracts by 2018. Technology helps RCM solutions support multiple reimbursement channels and meet consumers where they are.
- Cost management: A value-based health care system requires focus on costs, which have been a challenge for many hospitals to track, manage and ultimately contain. There is often great variability in costs from one provider to another – creating the opportunity to improve efficiency. New software solutions are allowing health systems to better understand their costs, find unnecessary and wasteful variability, and capture savings.
- Risk adjustment: Under the Medicare Advantage program, private health plans receive different payments from the Centers for Medicare & Medicaid Services based on the relative health of the patients they cover. Accurately capturing appropriate risk adjustment factors for patient populations is crucial to the financial operation of Medicare Advantage health plans. Cutting-edge technology companies are providing software tools that make the process of risk adjustment more accurate and efficient.
The processes involved with delivering care—from diagnosis to prescribing medication to ordering tests to invoicing and payment processing—fall within operations. As in other areas, new technologies are playing an important role in improving operations infrastructure and efficiencies. Examples include:
- Supply Chain Management: The supply chain is often a hospital or health system’s second-largest expense, behind only labor. A McKinsey study estimated making the health care supply chain more efficient could lead to $130 billion in savings. Harnessing data analytics and artificial intelligence is creating efficiencies in supply chain management.
- Natural Language Processing: Natural language processing (NLP) uses language and algorithms to derive meaning from data. Experts believe tools and software that leverage NLP, coupled with artificial intelligence, will lead to streamlined, intuitive workflows and powerful clinical decision support.
- Blockchain: Blockchain technology is thought to be useful in health care for managing health records and identity because the technology creates a transaction record that cannot be edited. Each chronological, time-stamped, connected ‘block’ links to the block that came before it. Blocks cannot be changed, deleted or modified.
The medical industry is facing pressure from increasingly empowered consumers who are demanding more information, greater choice, better value and enhanced technology that will make their experience in health care more efficient, enjoyable and less costly.
In the shift toward consumerism in health care, organizations must make an effort to provide exceptional customer service. Consumers seek demonstrable value from services and products, which must fit their lifestyles and beliefs. Health systems, technology providers and others are responding with a host of solutions aimed at attracting, engaging and retaining patients as customers. These include mobile apps, telemedicine options, online portals for communicating with providers, and other technologies. “Providers of care are starting to realize that they need to compete in the marketplace just like any other business does.” Paul Crnkovich, managing director at Kaufman Hall
- mHealth: Mobile health applications, or apps, piggyback on the ubiquity of smartphones to provide consumers with a range of health-related resources at their fingertips. Apps are being used to track health and activity levels, deliver educational resources, and communicate with providers via email, text and video. Providers are also exploring the role of mHealth apps for research purposes.
- Telemedicine: Telemedicine includes video, telephone, email and text message communication between a physician and a patient. Rock Health research finds the top three most popular telemedicine platforms are telephone (59%), email (41%), and text message (29%). However, video-based telemedicine is experiencing rapid adoption—it is also the platform with the highest satisfaction rate (83%).
- Patient Portals: Patient portals are secure websites that allow patients to interact with providers, pay medical bills and view medical information. The use of patient portals is on the rise: in 2017, a survey found 74 percent of respondents joined a patient portal in the past year. This trend is in step with consumerism in health care and consumer demands for transparency and service.
- BYOD: Bring Your Own Device in health care refers to a platform that allows patients to use their personal devices, such as tablets and smartphones, for telehealth and remote patient monitoring services, rather than a device provided by a doctor or hospital. BYOD grants greater consumer choice in devices, improved compliance when patients are familiar with devices and lower cost to health system from reduced hardware spending.
- Insurance exchanges: Set up by the government and private companies, insurance exchanges are websites that allow consumers to shop for and enroll in health plans. As more costs of health coverage are passed onto consumer, via copays and deductibles, patients are increasingly interested in comparing a range of plans to find the choice that’s right for them.
Data is the lifeblood of a value-based health care system. Health care organizations can’t improve – become less costly and produce better outcomes – without collecting, measuring and analyzing data from every process and interaction in the patient journey. Key technologies and strategies involving data include network, cybersecurity, unique patient identifiers, internet of medical things and big data analytics.
Data can’t move without robust information technology networks, which control and facilitate operations, storage, communications and more. A robust, forward thinking vision around network infrastructure is paramount to modern health systems—it must be secure, stand up to incredible bandwidth requirements, and be frequently maintained as new solutions and threats disrupt the landscape.
- Core network infrastructure: The network infrastructure of many health care organizations is in transition. Advancements such as electronic medical records, Internet of Medical Things and Internet-based applications have created new data, storage and traffic flow needs. Mounting cyberattacks increase security demands. Core network infrastructure is in flux between the traditional onsite data center approach and incorporation of cloud network technologies.
- Hybrid Network Strategy: Many health care organizations are at various stages of implementing a cloud network strategy or a hybrid network strategy, which uses a traditional onsite data center coupled with cloud network infrastructure. Cloud and hybrid networks make information accessible to multiple parties in multiple locations simultaneously through the connectivity of the Internet. They eliminate much physical storage and equipment and introduce different security measures.
Internet of Medical Things
Experts are predicting rapid growth in IoMT adoption: a recent report estimated 87 percent of health systems will have IoMT technologies deployed by 2019 as health systems look for opportunities to capture more data from their devices, systems and patients. The value of the IoMT market is expected to reach $163 billion by 2020. Health industry leaders need to be ready if they want to harness the technology for value-based care.
Patient health data has become valuable to hackers – driving up cyberattacks on health systems. Cyberattacks targeting patient data jumped 300 percent between 2014 and 2016; and the U.S. health care industry is spending an estimated $6.2 billion a year in fines and other costs related to health data breaches. As a result, cybersecurity is moving to the top of the agenda at health systems.
Unique Patient Identifiers
It is estimated that 10 percent of medical records are duplicates in the average health IT system. Misidentification of patients and duplicate information entered into health records can cause misdiagnoses, unnecessary tests, and inappropriate treatments, all of which hinders the ability to improve patient care and drives up medical costs. Unique patient identifiers are a key technology in solving this problem.
Big Data Analytics
Data analytics is a cornerstone of improving outcomes in health care. Health systems can’t improve what they can’t measure. Several key terms are:
- Big data: Health systems generate huge amounts of data, which can be compiled and analyzed to uncover better ways to deliver care.
- EHR: Electronic Health Records provide a real-time, secure and digital history of patients’ medical and treatment histories.
- HIE: Health Information Exchange is an information network that allows EHRs to be shared between different medical providers.
McKinsey has estimated that big data analytics could reduce waste and inefficiency in health care by more than $300 billion a year.