“We are focused on low-hanging fruit,” said Roy Schwartz, vice president of managed care and payer relations at Penn Medicine. Post-acute care can run up “half the price (of an episode of care) and almost 100% variability.” Penn is working with an outside vendor to get its geographically disparate network of post-acute care providers up and running on a common technology platform that shares patient information among providers. The system operates outside Penn Medicines electronic health records.
Healthcare systems also need to identify patients, who qualify for one of Medicare's new episodic programs. This is easy if someone is admitted for a scheduled surgery, but more difficult for patients who are admitted through the emergency room.
“If someone comes to emergency department with shortness of breath, it could be COPD, pneumonia, heart failure or influenza,” she Dr. Zenobia Brown, a medical director at NorthWell Care Solutions, in Great Neck, N.Y., adding that a hospital “could lose days waiting for the DRG to drop.” (A DRG is the diagnostic code that hospitals use for billing under fee-for-service payment; each bundle is comprised of a number of DRGs.) By that time a patient could be discharge or miss critical post-acute care guidance.
To find these patients, NorthWell created what it calls Care Tool, a platform designed for providers that coalesces information from multiple systems for each patient: the admission, surgical scheduling, electronic medical records, and (within the next year) pharmaceutical data. The technology also allows doctors and nurses to track a patients through different post-acute care facilities or even if they show up in emergency room of another hospital in the region.
Determining whether an organization is ready to begin coordinating care among outside providers goes beyond computing. Eliciting electronic feedback or data from patients requires having someone able to monitor and act on the information.
And that, in turn, requires designating a point person at every hospital within an organization, which may not be possible due to cost or other constraints. Northwestern Memorial HealthCare, for example, has seven hospitals. Its downtown Chicago hospital, Northwestern Memorial Hospital, is experimenting with one technology that monitors and engages patients and works optimally with a first responder or care navigator.
But other hospitals in its system don't have care navigators. “The landscape of solutions is fragmented,” said Dr. Hannah Alphs Jackson, program director of value-based delivery, Northwestern Memorial HealthCare.