By S. Michael Ross
We are on the edge of a cliff. In the United States, we are spending more on healthcare and deriving far less value than most other countries. The current national healthcare spending trajectory — $2.6 trillion in 2010 —i s unsustainable.
Fragmented care is a leading reason that costs are so high. It also jeopardizes patient safety. More than 50 percent of Medicare beneficiaries have five or more chronic conditions such as diabetes, arthritis, hypertension, or kidney disease, and, on average, visit 14 different providers at various facilities annually. The resulting uncoordinated treatment can lead to redundant care, superfluous testing, increased exposure to medical error, and unnecessary costs.
What if a health plan could reach members at the moment of care through their most trusted advisers — their physicians? According to a Microsoft study, 90 percent of people trust their doctors over all other forms of health information. One strategy for nationwide health improvement is fostering the physician-patient relationship. This can be highly effective because it encourages patients to engage in their own treatment plans. We are rapidly moving to a system in which more of the accountability for clinical outcomes is being transferred to the providers, and the economic incentives are being aligned. Equipping providers with the right information to be delivered at the right time is an essential tactic to bend the cost trend and enables the accountable provider to deliver better quality of care.
The patient-centered medical home (PCMH) is one collaborative value-based model gaining traction in the medical community as an antidote to fragmented care. However, for collaborative models to achieve desired cost and clinical results, communication between health plans and providers must be better cultivated..
Increased coordination means chaos if the data is not synchronized. Health information technology (HIT) plays a pivotal role in enabling providers, health plans, patients, and others within the healthcare continuum to share information. Merging clinical information from the provider side with financial and administrative data from the health plan side, for instance, delivers unified intelligence and permits everyone access to a more complete picture to support patient care. One way that this goal can be accomplished is through a single, multi-payer, secure, real-time source of patient-related clinical information.
One essential aspect to achieving the desired outcomes is workflow integration. In order to effectively coordinate care — and to avoid confusion at the provider level — data must be presented in a standardized, uniform manner across all health plans. In addition, the information must be easily accessible. Providers need to be able to access data across a variety of technology platforms, including portals, smart phones, and tablets.
When information is delivered by a provider at the moment of care — as opposed to a health plan — it carries far more credibility with patients. The ability to integrate health plan claims-derived gaps in care with provider electronic health record, practice management, and scheduling systems results in a far more timely and accurate approach to communicating with patients about preventive and chronic care. By acknowledging that physicians are the most effective channel for this communication, health plans can help strengthen the provider/patient relationship, increase the quality of patient care, and save on administrative costs.
Today, health-care communication networks are starting to make the vision of care collaboration a reality. Early pilot results on PCMH confirm that this model saves money and improves clinical quality. By bringing health plans and providers together through real-time data exchange, the health-care industry can coordinate care and align reimbursement with patient outcomes. From there, it is a much shorter step to the end goal of reducing costs while improving the quality of care. We have the opportunity to rapidly achieve better health of our people — and to bend the cost curve.
Dr. S. Michael Ross is chief medical officer of NaviNet, a health-care communications network.