The transition to value-based care
One of the more significant challenges facing healthcare organizations is managing, under increasing pressure, to lower cost and improve quality while being paid largely on a fee-for-service basis. It is likely that a meaningful transition to value-based reimbursement will take a number of years, and that organizations will be required to practice in “the gap,” under misaligned incentives and with competing priorities.
There are many high-level, multi-step proposals for winning strategies to manage the transition from fee for service to fee for value. Steps range from the relatively concrete (eliminate waste) to the abstract (collaborate) with virtually unlimited permutations between. Each step has merit. Each, however, is real work that will need to be done in addition to managing a traditional fee-for-service organization through pervasive regulatory requirements, reimbursement compression and rising administrative costs.
The answer to managing an organization through “the gap” may be found by borrowing an approach used by elite musicians and athletes called “deliberate practice.” Deliberate practice means choosing a very small part of your skill set and consciously working at your skills until you are unconsciously competent. Applied to a healthcare organization, this implies choosing a single, meaningful step toward value-based care and focusing on it until the organization is unconsciously competent – until it is automatic.
Here’s a great place to start: Deliberately practice a step, such as calculating cost, profit and loss per service or service line. That step is both helpful in resolving a fee-for-service pain point and core to delivering value-based care.
ACO obstacles
Since the Medicare Shared Savings Program established the guidelines for the creation of ACOs in 2011, they have been touted as the instruments to fundamentally disrupt unsustainable growth in healthcare spending. Through the conversion of fee for service to fee for value, healthcare providers can be incentivized to focus on population health and reduce unnecessary high-cost services, resulting in shared savings between payers and providers. Of the 32 chosen as the initial pioneers of the program, however, only 13 realized any shared savings, and two owed Medicare $4 million, leading to an exodus of nearly one-third of the pioneers from the program after the inaugural year.
What led to such a turbulent start? Not surprisingly, data sharing, communication and patient facilitation were noted as some of the largest obstacles to developing meaningful savings. Before considering a move to an ACO, healthcare executives should evaluate a few key tenets of the technological geography of the patient population, including the capabilities and enthusiasm for current legacy systems, the use of patient portals and electronic communication, and the penetration of mobile and smartphone technology.
Unlike prior attempts of consolidating care, the preservation of patient choice and physician independence within an ACO precludes the classic one-size-fits-all, top-down approach to information systems. Any solution must work alongside existing legacy systems, patient and physician portals, and function seamlessly on preferred devices (smartphone, tablet, desktop). Any less will result in a loss of patient and physician enthusiasm and a loss of savings.
Online interventions key to effective behavior change, health improvements
Today, it is more crucial than ever that we provide relevant and meaningful programs to help reestablish and support healthy habits and lifestyles. In particular, online programs have proven to increase physical activity, improve nutrition, support patient self-management and effectively manage chronic diseases.
For group practices and hospitals, online interventions accomplish this by extending their reach beyond the boundaries of the office or hospital. Participation in a 24/7 online self-management support program deepens the relationship between the provider organization and the patient, and expands the relationship and engagement into the daily lives of patients, even when they are not taking part in in-person care. Additionally, it’s estimated that for many patients, self-care plays a greater role in health and health outcomes than medical care. Providers can promote and support self-care through online programs that serve to complement and improve their own efforts in a cost-effective manner.
Technology-enabled online services, such as Virtual Lifestyle Management (VLM) from DPS Health, facilitate patient-clinical communications by addressing patients’ needs. Patients are at the center of their own journey to healthier lifestyles over an extended 12-month period. Programs that focus on patient behaviors and lifestyle provide support within the context of patients’ everyday lives and for things that are important to them, such as diet and physical activity. This approach creates a platform of trust and communication between the provider and patient, and this ongoing trust provides opportunities for providers to broaden the communication to areas beyond self-care.
Further, online lifestyle programs complement other wellness activities, such as challenges, incentives and health reimbursement accounts (HRAs), by providing a deeper, longer-term and more engaging connection beyond what other wellness services offer. These lifestyle-management programs also supplement chronic disease initiatives, providing the complementary lifestyle support to their focus on medical issues.
In conclusion, online lifestyle interventions provide value to group practices and hospitals in promoting improved self-care, engaging patients beyond the providers’ walls, providing a relationship platform for further communication, complementing wellness activities and extending chronic condition-management services.
Closing an open door in healthcare IT security
EHRs are a helpful way for medical professionals to keep track of patient records, but the information in these records can be easily compromised. In fact, the FBI estimates healthcare fraud costs the country $80 billion each year.
Today’s exam rooms are equipped with PCs that require the provider to log into the patient’s EHR. But what happens if the provider is called away from the room or forgets to log out before finishing with a patient? The patient’s records are now easily available to the next person who enters the room.
One example of how technology may find a way to prevent this in the very near future is with a form of endpoint access control. Using near-field communications (NFC), hospitals can link a provider’s EHR login to their immediate location. If they log into a patient’s file, but must step out of the room, they are immediately logged out.
Similar types of innovative secure access are already being used in the United States to increase the integrity of health data. In 2011, Seattle Children’s moved to secure token technology for remote access of EHRs using multi-factor authentication, an additional layer in secure access authentication to the network.
As more healthcare professionals tackle the burgeoning threat of patient identity fraud, NFC and multi-factor authentication are solutions that merit a closer look.
Direct messaging enables secure, swift and streamlined communication
When fax machines were cutting-edge technology decades ago, they offered many time- and cost-saving benefits over mailing health information or sending it via courier. Until recent years, it has been the preferred route for exchanging health information between providers.
Although technology advancements have improved faxing to some extent, it still presents many security and workflow challenges tied to practice management. Whether someone dials a wrong number or unauthorized individuals obtain faxes, security breaches are common; there is simply no way to ensure faxed documents remain with the intended parties. Furthermore, faxed content is often created by the sender printing from the EHR, and then the recipient of the fax scans it back into the EHR. These additional manual steps significantly affect the workflow and increase costs on the practice.
With the evolution of EHRs, the direct messaging protocol will rapidly begin replacing fax technology because it offers greater security, real-time message delivery, enhanced patient engagement and other workflow efficiencies.
Direct messaging enabled within an EHR allows providers to send encrypted documents electronically to certified individuals, including patients or other providers. This eliminates the expense of mail or courier, and minimizes the security breaches that plague both faxing and mailing. Additionally, direct messages are automatically tracked and logged by the EHR, improving auditing ability.
More than just a protected email platform, direct messaging can help streamline PM and assist organizations attesting to MU by enabling electronic – and reportable – communication among providers, organizations and patients. A secure resource for information exchange, direct messaging allows healthcare organizations to reallocate valuable resources, improve workflow and streamline communication processes.
Balance long-term vision with short-term management strategies
Successfully managing a physician practice requires a keen ability to juggle competing priorities. Practice administrators and reimbursement managers, in particular, must weigh day-to-day needs against long-term goals. Implementing an EHR, preparing for ICD-10 and getting today’s claims out the door, for example, are all equally important tasks.
The key to developing an effective practice-management strategy is to continually plan for the future as you monitor daily indicators. For instance, in my years as a reimbursement manager, I spent time every day tracking charges entered and payments received. I checked to see if hospital charges were entered within 24 to 48 hours, whether office charges were timely and whether denials were worked within 48 hours.
With technology, practice managers can quickly track these kinds of daily metrics and use the data to analyze trends and identify opportunities for improvement. That’s where the long view meets the daily routine.
Although my short-term goal was simply to ensure we were paid, my long-term objective was to develop processes that would result in faster, more accurate and more efficient reimbursement. Our goal was to keep in mind the larger effects of not being paid – each day that we weren’t paid could weaken our revenue cycle. Those dollars might be earmarked for EHR implementation or ICD-10 training, for example.
It’s easy to get stuck in day-to-day operations. Using straightforward data, practice managers can measure both where they stand today and how close they are to reaching their long-term goals.
Easing financial and practice operations
During medical school and residency, physicians learned how to diagnose and treat patients, not become accountants, coders and office managers. Nevertheless, every successful practice requires attention to the financial side of medicine – something everyone in a practice must understand to some degree.
While the goal of EHRs is to allow physicians to monitor and analyze their patients’ health outcomes, PM systems should allow them to monitor the financial health of their practice.
More so, flexible, cloud-based PM systems can make it easier for physicians to visualize their practice’s revenue and expenses. At a glance, physicians can assess collections, claims success rate, accounts receivable trends, copays and other indicators on dashboards. On the operational side, verifying eligibility and benefits, scheduling appointments, and coding and submitting accurate claims should be intuitive and streamlined on these systems.
If data from PM systems can seamlessly integrate with a practice’s EHR data, it will eliminate data entry time for clinicians and allow office staff to promptly code and bill claims. This translates to cleaner claims, higher acceptance rates and faster cash flow for the practice.
Practices should demand PM systems that will automate and streamline the time-consuming financial and operational tasks necessary for everyday operation, regardless of specialty. These systems should also minimize the complexity of practice business operations and allow physicians more time to focus on their patients.
