Experimentation. Disruption. Innovation. The spirit of change was in the air at last week's Healthcare Information and Management Systems Society annual meeting in Las Vegas.
It was easy to miss since the major players in the field offered plenty of reasons to be cynical. It began with the federal Office of the National Coordinator for Health Information Technology organizing all the leading players in the health IT world to make their annual “interoperability is just around the corner” pledge.
A year ago at the same show, the ONC unveiled its road map to a land where an individual's electronic health records flowed seamlessly between healthcare providers and popped up magically at the point of care. The goal: full and easy exchange of records by the end of 2017. Does anyone seriously think that's going to happen?
It would require that major vendors like Epic Systems Corp., Cerner Corp., Allscripts and Meditech agree on common standards. They haven't. It would require that providers allow their—whoops, your—records to flow easily to competing systems. They don't.
As Modern Healthcare's Beth Kutscher reported from the show, California's major insurers' efforts to create a universal cloud-based records platform called Cal Index has been slow to take off because major providers in the state are reluctant to get on board. That reality makes CMS acting Administrator Andy Slavitt's call for chief information officers in healthcare systems to “call out” vendors who block data transfers sound hopelessly naive.
The problems with existing health information technologies go well beyond their lack of portability. Physicians complain bitterly about inflexible computer software that doesn't mesh with the daily work that goes on inside their offices and hospitals. It turns out that a medical record system designed to maximize billing opportunities in a fee-for-service payment system is not what a physician or a nurse needs.
Oh, did you think the nation was well on the road to substituting “value-based reimbursement” for fee-for-service medicine? Rebranding penalties for excessive readmissions as value-based reimbursement isn't the same thing as taking on full risk for delivering unnecessary or avoidable care.
My numerous conversations with major consulting firms at HIMSS followed a depressing pattern. Their clients—both payers and providers—still have anywhere from 70% to 90% of their payments flowing in the traditional piecemeal fashion.
None of the consultants' provider clients anticipate a major shift away from fee-for-service. Even where services are bundled, providers are carefully tracking their resource-use patterns to justify future calls for increases in bundle prices. But at the same time that major systems are protecting their existing revenue streams, many are laying the groundwork for major changes.
The driver will be the next generation of healthcare consumers, an Uberized millennial generation that expects convenient service, digitally enabled access and Yelp-like price and quality transparency. They will be incentivized by the employer-based insurance system, which is increasing workers' direct exposure to costs through high-deductible plans. For care that is not time-sensitive, consumers with skin in the game will be motivated to search out providers whose price and quality mix meets their needs.
There was no shortage of small companies at HIMSS that are developing database-driven software, services and apps to meet this future demand. Health systems are empowering newly formed innovation departments to seek those green shoots out, nurture their growth (sometimes by investing in them) and deploy their technologies.
Another class of startups is creating new technology-enabled services such as telehealth and early identification of at-risk individuals for chronic-disease interventions. Successfully managing large populations, whether at the health system or the community level, will require these new tools.
Many of these new companies will fail. But some will succeed. Those that do will eventually create a reimbursement environment where value-driven care is not only possible, but inevitable.
