mgma of greater st. louis 2014

Current & Emerging Technologies Supporting Patient Centered Care

Ben Quirk

Quirk Healthcare Solutions

Person Instead of Patient

• Patient centered care can only go so far. We are now being held responsible for what patients do when they leave the clinic and become people again.

• The power of each individual is unleashed to be active in managing their health and partnering in their health care, enabled by information and technology.

Personal Behavior

• According to BCBS foundation, 70% of

all healthcare costs are caused by

personal behavior.

• In addition, nearly three-quarters of all

costs can be traced to cardiovascular

disease, diabetes and obesity.

The New Healthcare Paradigm

ONC’s Core Values

• Individual self determination and the public good are both optimized.

• People can decide whether and how much to participate in managing their health and health care.

• People can access wellness and health care services enabled by technology that reflects their individual needs, values, and choices.

• Health care is a partnership between the patient, their caregivers, the care team, and supporting services.

• Information is shared as appropriate, between the individual and all their care partners to enable informed, participatory decisionmaking as desired by the individual.

Why Do We Care?

• “We will replace once and for all our fee for service model with provider-led community wide care that can compete on quality, value over volume.” Hillary Clinton, HIMSS 2014

• “Transforming health care to slow the growth of spending requires a radical restructuring of how health services are paid for. The most powerful way to reduce costs (and make room to expand coverage) is to shift away from ‘volume-based’ reimbursement (the more you do, the more money you make) to ‘value-based’ reimbursement.” Newt Gingrich

Physicians Are Already Paid Based On Health of Patients

• In the Value Based Payment Modifier, we are judged on outcomes not just reporting data.

• These outcomes will be published on the Physician Compare website and are already published by some Commercial Payers.

LOOK INTO TECHNOLOGY

Healthcare Technology

• Dan Holleran:

• Medtronic Minimed 530G Enlite

• Medtronic CareLink USB

Healthcare Technology

• Wellpoint already provides seniors with chronic diseases in-home monitoring equipment that alert to issues:• Diabetes – Glucometers

• Hypertension – BP cuffs

• CHF - Scales

Patient Portals

• MU2 requirement for interaction with portal and message to doctor.

• Responsibility is put on the provider for adoption.

Data Aggregators

• HIEs consuming data and bringing them to payers and ACOs to identify trends.

• MU2 requirement for creating and sending a CDA for transitions of care.

• MU2 requirement to codify chart with SNOMED.

Wellness Technology

• Fitbit, Nike Fuelband, etc

• Calorie Counters

• MyFitnessPal

Nutritional Literacy

• Calorie counts on menus.

• Healthy options at chain restaurants.

• Smoking bans.

REMAINING HURDLES

Separation Between Healthcare and Wellness

• Healthcare• Healthcare technology

• Patient portals

• Data aggregators to pull together micro and macro patient trends

• Wellness• Wellness technology

• Nutritional literacy

Data Aggregation

• Integrating HIE and wellness data into clinical visit.

Pay for Value

• Reimbursement model to support care coordination and reduced visits.

Closest Solution: Apple Health

• Despite current challenges, Apple Health is a strong push into bringing health and wellness data into clinic and engaging with patients when they become people.

• Uptake and efficacy remain to be seen.

A CASE STUDY: “SAVANNAH INNOVATION CENTER”

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The Underpinnings

• NextGen EHR for clinic EHR

• Netpulse for wellness integration

• Mirth to compile claim, clinical, and wellness data into actionable care management

2020: WHERE WE WILL BE

Where ONC Wants Us to Be

• Self management and prevention – Persons are educated and make informed choices.

• Interactions – Healthcare data flows fluidly to persons and vice versa.

• Shared management – Providers are responsible for persons actions outside visit.

• Cross-cutting – Breaking down the barrier between health and wellness.

The Rest of The Story

• Apple Health will make wellness fashionable.

• The reimbursement model to support the personal technology and fewer visits will come from payers and employers.

• Fee for service will be increasingly replaced by pay for value.

• Physicians who don’t make change will be see lower reimbursement or be removed from networks.

QUESTIONS?

For More Information:

• Ben Quirk

• Quirk Healthcare Solutions

• info@quirkhealthcare.com