We’ve all heard the mantra about how technology will transform the healthcare industry—it will revolutionize the way doctors practice medicine, improve the patient experience, and make payer-provider communications more transparent. The industry has developed some very impressive solutions to support the revolution, but technology doesn’t do much if no one uses it, and before they can use it they have to locate the funds to buy it.
We’ve all heard the mantra about how technology will transform the healthcare industry—it will revolutionize the way doctors practice medicine, improve the patient experience, and make payer-provider communications more transparent. The industry has developed some very impressive solutions to support the revolution, but technology doesn’t do much if no one uses it, and before they can use it they have to locate the funds to buy it.
Getting providers—especially those in smaller practices—to adopt eHealth technologies is one of the toughest obstacles for the industry and finances play no small part. Many solutions have been contemplated and even implemented, most revolving around elaborate ROI calculations for the practices, or getting hospitals, health systems and RHIOs to bear some or the entire financial burden.
EMRs and other technologies are great for hospitals, which can generally afford to invest the time and money in these new systems, but the vast majority of doctors in the United States work outside the hospital, and most of those physicians are in practices of five or fewer docs, with limited resources, tight budgets and little time to spare. The shift from phone, fax and paper to digital healthcare that yields significant but diffuse and non-billable benefits won’t get done effectively and on a wide scale on the physicians’ dime. We cannot expect practices, which are under growing financial pressure, to spend a significant portion of their annual earnings on technology that won’t necessarily affect their bottom line in the near term.
Leverage
Health plans are actually natural sponsors for technologies that will benefit the physician practice. Payers have the financial resources to invest in technology, they have the physician networks to distribute that technology with significant economies of scale, and they derive immediate and significant financial benefit. Practice automation, digital communications, electronic patient records, ePrescribing, care management, pay-for-performance (P4P)—all of these benefit payers in numerous ways by decreasing overhead associated with managing communications, by keeping their provider networks happy and stable, by facilitating cost-saving medical/disease/care management programs and by reducing cost of care by keeping patients healthier. Most of those are also benefits that pay off in the short term.
Payers are not only financially geared to benefit from technology but they also serve as an excellent complement to the hospital, health system or RHIO. Payer data provides a much more longitudinal view of a patient than provider data. Every action taken at every hospital to which that patient has been admitted, every prescription that is filled (actually filled and refilled, not just prescribed), every X-ray, every referral, every single action that has a cost is documented in the payer data. Because payer data offers such a complete view of the patient, it makes sense to have eHealth technology populated by this thorough source of medical information.
Multi-sponsor Solutions
Thousands of physicians across the country are already taking advantage of free multi-sponsor communication Web sites or similar solutions that are supported by health plans, their partners (such as disease management services firms) and other players who benefit from electronic communications with large networks of physicians. Multi-sponsor communication solutions provide physicians and their office staffs with a single and secure point of access to a number of organizations with valuable member data. They only need to remember one username and password, and they do not need to toggle between proprietary Web sites.
Physician practices that take advantage of these systems benefit from increased operating efficiencies, as well as being able to provide better care for patients and take advantage of new revenue opportunities.
Despite the clear benefits to payers mentioned above, the fact that major national and regional plans have had the vision and foresight to get behind multi-sponsor communication initiatives is extremely significant. These are highly competitive organizations, which have fought tooth and nail for customers and providers for years. The collaboration exhibited between plans that cosponsor a solution—to the extent of putting their proprietary data and transactions on the same system—speaks volumes about the tremendous benefits the multi-sponsor approach yields. Ultimately, as we have seen in many industries during the age of the Internet, these forward-thinking health plans recognize that the convenience and the efficiency that providers associate with one-stop Web-access to multiple entities (such as the Travelocity or Amazon business models) results in advantages that far outweigh those gained through more proprietary approaches. These health plans reap the rewards in the forms of much higher electronic transaction volumes, impressive ROI and improved provider relationships.
New Initiatives
Healthcare companies of all sorts are stepping forward to expand the functionality and benefits of these Web systems into new areas, such as P4P and disease management incentive programs. These new initiatives will go beyond offering operational efficiencies to providers; they will deliver clinical information directly into the provider office workflow at the point of care, facilitating greater physician involvement in sponsor-driven patient care programs. In fact, the best of these solutions can intelligently insert relevant clinical and administrative data into the practice’s daily workflow when—and only when—it is appropriate. This context-driven approach is critical to the success of initiatives like disease management and P4P where a visit by a patient that is a part of a program that indicates a certain action during a certain type of appointment (e.g., giving a foot exam to a diabetic patient during an annual physical) occurs relatively infrequently. For example, upon doing an eligibility inquiry prior to the physical, the multi-sponsor Web site would alert the physician office staff to the patient’s participation in a certain program.
Providers across the country are already logging on to these multi-sponsor communication systems daily to help streamline their office workflow and payer-provider communications. The largest site boasts a provider network of more than 200,000 physicians, whose staffs use the solution to interact with health plans and other organizations. Web sites like these drive both collaboration and adoption, and offer clear and immediate financial incentives.
One can imagine a future where payers and providers alike will view the multi-sponsor system as a natural, essential and common utility to the healthcare infrastructure.
