ST. LOUIS — December 10, 2013 — Recently, health economists and policy experts have started crediting innovations spurred by the Affordable Care Act (ACA) for the decline in the rate of health care spending. With more than 500 accountable care organizations (ACOs) in the United States today, and nearly 10 percent of consumers receiving their health care through an ACO, value-based care has become a major force in helping the industry achieve better health outcomes, lower costs and improved patient plus physician satisfaction. Lumeris, an accountable care innovation company, launches its predictions for value-based care in 2014. These predictions cover five areas at the forefront of improving the health care system.
1. Health care spending will increase if we fail to manage high-risk patients and events.
The costliest 1 percent of patients account for 21 percent of U.S. health spending, according to a Kaiser Health News report done in conjunction with The Washington Post. Without Care Management programs that provide the technology, tools and workflows to support physicians, care managers, care coordinators, and social workers in the stratification, engagement and management of high-risk patients and events, the industry will struggle to provide better quality care at a lower cost for people with multiple health and social needs. “High-risk patients represent significant utilization and an increase in spending that does not typically result in quality improvement,” said Lumeris Medical Director, Deborah Robin, MD, MHCM. “To achieve better care at lower cost, health systems need to change the way they manage high-risk patients and create an entire care community that works together to ensure each patient receives the right care, in the right place, at the right time.”
2. EMR technology alone is insufficient for population health management.
In a recent study from the Annals of Internal Medicine involving 1,820 primary care physicians, nearly half reported that they could not generate quality metrics using their Electronic Medical Records (EMRs), or exchange EMR information outside their practice. “Meaningful Use percentages for EMRs are inflated,” said Lumeris Vice President of Technical Solutions, Keith Blankenship. “Population Health Management requires a holistic view of a patient’s and a population’s information. Without widespread EMR adoption and tools such as Lumeris’ Accountable Delivery System Platform (ADSP)®, clinical information at the patient and population level is not available in a usable, readable format.” Keith predicts that without the proper incentive to use tools and information, physicians will slowly move to Stage 2 Meaningful Use, and the industry will never fully realize the quality improvement and cost-saving promises of technology.
3. Physician burnout will increase unless we get providers off the hamster wheel1.
Research shows that primary care physicians are more dissatisfied with their careers than ever before. According to a recent JAMA study, nearly half of U.S. physicians are experiencing symptoms of burnout. With the Congressional Budget Office estimating 25 million previously uninsured patients becoming health care consumers in the next two years, fee-for-service physicians—who provide the care necessary to qualify for reimbursement in a fee-for-service compensation model—will become even more overloaded than they are today. “The image of ‘hamster wheel health care’ depicts the futility of this model as physicians must run faster and faster to increase the volume of services, while billable revenue per service declines,” said Lumeris Director of Innovation Research and accountable primary care physician, Tom Doerr, MD. Dr. Doerr predicts that once physicians restructure their practices for value-based care and are given the incentives, tools and information to manage their patients and populations, they will find satisfaction in their work and avoid burnout.
4. Payers and their network of providers will assume greater risk under the ACA.
One of the main challenges for insurers in the Health Insurance Marketplace is a lack of information on the projected 25 million consumers who will enroll, according to a research paper published by The Center on Budget and Policy Priorities. The paper suggests that managing this risk requires gathering the right data on the new population quickly. “Managing risk in the marketplace requires a proactive and prospective approach,” said Lumeris Director of Accountable Care Consulting Services, Terri Bellmore. “As health plans and providers assume risk for this population, they need to prospectively assess a patient’s health status, and then properly document and code the conditions in order to manage risk and receive optimal reimbursement.”
5. The impossible task of leveraging big data will be possible with interfacing.
In a recent HealthITAnalytics article, clinical data integration is one of the key first steps to value-based care. However, it’s a timely and expensive process that Lumeris estimates can cost health systems up to $100,000 a year. “The industry will continue to struggle with integration because EMRs have been designed as closed systems, making data exchange a complex process,” said Lumeris Vice President of Technical Solutions, Keith Blankenship. “Integration is trying to force EMRs to do what they are not designed to do. A much easier solution is interfacing—when data can be combined to produce powerful information for physicians at the point of decision.” Keith predicts that in 2014 interfacing will make it possible for health systems, hospitals and provider groups to more cost-effectively and quickly extract data from hundreds of different EMR and Practice Management Systems without disrupting practice operations or patient care.
1Morrison I, Smith R: Hamster Health Care: Time to stop running faster and redesign health care. BMJ 2000, 321:1541-1542.
Lumeris is an accountable care delivery innovation company offering health systems, payers and providers operational support, technology and consulting services. Our technology-enabled solutions and services help health care organizations design, build, operate, measure, and optimize any accountable care model to accomplish the Triple Aim Plus One: better health outcomes, lower costs and improved patient plus physician satisfaction. The depth and breadth of Lumeris’ solutions—combined with its near decade of experience in accountable care—make the company an ideal partner for any health care organization seeking the benefits of a better connected, aligned and informed accountable delivery system. For more information 1.888.586.3747 or Lumeris.com.