Health IT key to ensuring payment under new quality-based model

Sept. 25, 2013

One of the largest components of healthcare reform – and one of the most difficult for practices to manage – is the transition from a fee-for-service model to one that rewards for value.

Transformation is part of the growing process; as industry changes, so must the businesses connected with it. And it’d be difficult – if not impossible – to find an industry that has undergone more changes over the past several years than healthcare IT. Embracing that spirit of change, then, the goal of healthcare IT shouldn’t be to reinvent the wheel, but rather implement the best tools to maximize quality of care while reducing cost.

Under an umbrella of a variety of systems, practices and providers are going to be more dependent than ever upon IT solutions to keep track of patient data, while simultaneously ensuring that data is secure. But it’s not enough to simply have and hold; the data must be utilized in a meaningful way.

As the U.S. healthcare model changes from rewarding for quantity to rewarding for quality, disease management is projected to be one of the fastest-growing segments in the industry, with healthcare IT vendors scrambling for a piece of the proverbial pie. Connecting big data to population health through analytics will be imperative if we are to reduce the number of patients readmitted for the same condition.

Additionally, with a major focus on electronic medical records (EMRs), electronic health records (EHRs), ICD-10 and meaningful use, it’s tempting to put health information exchanges (HIEs) on the back burner. But that’s not an option. Communicating in a digital healthcare environment without HIEs is like trying to navigate a highway system without freeways.

Ideally, HIEs would facilitate the sharing of data between doctors’ offices, practices, hospitals and laboratories; everyone with a viable need would share records, and security levels would be determined by the type of information and who was asking for it. These free-flowing, robust systems would allow proprietary laboratory information systems (LIS), picture-archiving communications systems (PACS), EHRs and more from different vendors and hospitals to communicate seamlessly with each other.

Effectively and successfully managing a practice in today’s world means balancing day-to-day operations with long-term goals. These include making the move to value-based care, determining the best ways to engage patients, managing chronic diseases and conditions, implementing solutions, maximizing security and keeping a watchful eye on finances and the revenue cycle. 

Motivated by a governmental push, reform is happening; it’s up to the vendors and end-users to figure out how to best facilitate the process – from development to selection to implementation of solutions and, finally, the logistics of day-to-day operations. The end-goal is demonstrating quality of care; the tools are healthcare IT solutions; the rewards are payments in the form of reimbursements and incentives – but the big payoff is improved patient care.

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