Priorities/Recommendations: Financial Performance


ONC Goal II:Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT (Goal II discusses the specific ways health IT is contributing to the goals of the Affordable Care Act.)

Goal:
With payment increasingly based on value, not costs or pre-determined rates for services, health information technology is essential to achieving financial results, especially in this era of changing payment models.

  • Use Health IT to demonstrate the value delivered
  • Use Health IT to increase the value (improved outcomes, reduced costs)
  • Use Health IT to manage the costs of providing care and achieving results
  • Establish baseline costs for implementing Health IT


Rationale:

The nation must improve, dramatically, its healthcare system and get better value at lower cost. There is continuing pressure on traditional payment streams. Payment schedules are being reduced while the unit costs to provide care continue to rise. Innovation is required to survive. The new payment models, such as Accountable Care Organizations and Bundled Payments, look to manage the overall cost of care across settings. In order to survive and even prosper, providers need to improve the value they deliver to their customers (patients, residents, families, other providers and payors). This can be accomplished through many means, almost all of which can benefit from use of health information technology.


Long-term and post-acute care is part of the solution. The LTPAC providers offer care settings and the appropirate resources for individuals who need extra time to recover from illness or need support in activities of daily living. Health IT is important for providing these services.

The need to support this new model comes from many causes including an aging population, prevalence of chronic disease and inefficient delivery systems. New models are emerging in voluntary partnerships and in regulation. Pressures on the short-term acute-care hospitals to improve their re-admission rate provide an opportunity and a challenge to post-acute providers. As hospitals face financial penalties for readmissions, there will be monetary value to partners that can manage discharges and reduce the readmission rate. Post-acute providers also have a direct stake in this changing model. For example, the American Health Care Association, representing nursing facilities, recently proposal that rather than reduce funding for bad debt, that nursing centers demonstrate system-wide savings from reductions in readmissions. Failure to achieve the savings would result in future payment reductions. [Nursing home industry proposes alternative to funding cuts, Julian Pecquet, January 30, 2012 http://thehill.com/blogs/healthwatch/medicare/207403-nursing-home-industry-proposes-alternative-to-funding-cuts ]

In summary
  • New/emerging models that address overall cost for care/shared risks
  • Partnerships with physicians, acute care hospitals, other post-acute providers, payors,
  • Shift to payment for value with increasing outcome reporting and cost transparency
  • Health Information Technology is a key enabler for improved communication and efficiencies, however, it must be tuned within the particular environment to achieve these goals

Objectives: (Measurable Outcomes)
  • Health IT that supports the changing environment. More is needed from Health IT than to collect the data necessary for mandatory assessments and billing. HIT must be more deeply integrated into the care process, collecting and sharing information in ways that streamline activities and allow for better management of resources and risks. This includes support for care transitions and care within a setting.

  • Certification criteria specific to LTPAC. The Commission for Certification of Health IT (CCHIT) with leadership from LTPAC providers and vendors, defined certification criteria in 20xx. To date, xx vendors have passed the certification process. We should assess the effectiveness of this certification as well as what is most relevant today.

  • Provider organizations must be capable of implementing the necessary systems. Beyond the availability of sufficiently robust HIT technology, providers must configure the systems for their organization, train staff on their use and learn how to use the systems as part of improving outcomes. This takes time and resources. We should track the breadth and depth of implementations.

  • Success in using HIT to achieve improved outcomes. The goal is not to have systems for systems sake, but to improve care and to improve the operations of provider organizations.


Strategies: (How we will achieve the Objectives)
Information systems to
  • Better engage with partners
  • Manage care transitions
  • Manage care within a setting
  • Document patient status, care plans and care provided
  • Report outcomes by multiple criteria/categories
  • Identify care/cost risks and support prevention/early intervention
  • Increase staff/resource efficiencies/effectiveness
  • Continued importance of documentation to support patient status/acuity and track costs
  • Three innovator roles
    1. Inventor (major new technology)
    2. Tweaker (modifies the technology)
    3. Implmenter (scales out the technology)

Suggested Speaker(s) at Summit:
  • CIO from the CIOConsortium
  • A non-technical senior executive who "gets it"
  • Atul Gawanda
  • Chip Heath or Dan Heath
  • Someone from private insurance company? Managed care? ACO?

Resources
Leading Age Case Studies, November 2011


CIO Consortium EMR Cost Study, February 2011


Health Affairs: Melinda Beeuwkes Buntin, Matthew F. Burke, Michael C. Hoaglin and David Blumenthal,
The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results
Health Affairs, 30, no.3 (2011):464-471


CAST - HIT Financing Estimate for Nonprofit Long-Term Care Providers in California:


New York State Studies of Nursing Facility and EHR Usage

Innovation and the need for three roles: inventor, tweaker, implementer plus the importance of multiple incentives and workforce factors