The rapid rise in healthcare spending in the US has spurred the launch of a myriad of initiatives to bring the runaway growth in healthcare costs under control. The payment environment will move away from the traditional fee-for-service model, which has failed to yield cost savings or quality improvements, and toward a formula that promotes value for patients and efficiency for the system overall. The success of the initiatives that aim to enhance the quality of care, improve efficiency and enable care coordination depend on successful implementation and integration of healthcare information technology (“health IT”) into primary care practices.
In Hawaii and elsewhere, the imperative to control healthcare costs has forced large hospital systems to adopt costly heath IT solutions to improve quality and efficiency of care. These enable complex data analytics, clinical decision support and population health management functions to improve quality outcomes. They also form the backbone of developing health information exchanges that aim to connect a broad spectrum of providers and patients to facilitate better care coordination and shared responsibility.
There is a shift in the healthcare payment model from Fee for Service to Fee for Value, moving away from Claims Payments to Quality Bonus to Quality-Based-Reimbursement. Full capitation is the ultimate model where physicians/ACOs get paid a fixed fee for health value outcomes. The only way to prove these favorable outcomes is through EHRs that can capture the structured clinical data and report progress on value measures. Those physicians that adopt the PCMH model and required technology to prove the creation of healthcare value over time will be able to compete in the marketplace for government payments, insurance reimbursements, or patients.
While it seems only large hospital systems may be able to afford the health IT necessary to execute the new healthcare models such as the Accountable Care Organization (ACO) or PCMH, primary care physicians will be crucial to delivering improved quality and better coordination of care in every healthcare initiative. That's because the goals of all such programs are to enhance delivery of care for both the individual patient and the population, while lowering costs. Especially the avoidable costs related to hospital admissions. So while hospitals may have the financial means to pay for costly health IT systems, their future business will depend upon ambulatory care referrals.
So instead of losing market power and leadership in the changing healthcare industry, the traditional family doctor remains the lynchpin of the future healthcare system. Importantly, the new models of care aim to strengthen the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship, which must be managed by the patient's primary care physician.
Those primary care physicians who are able to utilize health IT to transform their practices to deliver better care for individuals, better health for populations, and lower costs will gain a competitive advantage in the marketplace. Whether the ACO, PCMH, or some other healthcare delivery model prevails in the rapidly changing regulatory environment/healthcare marketplace, physicians who implement and integrate technology solutions that provide tools to improve quality and efficiency of care will be rewarded with enhanced payments and incentives.
While large hospitals and health systems have led the way in Hawaii with their investments in health IT, there are a number of EHR products in the marketplace that are affordable for the independent physician. Not all health IT solutions are the same, however, and the system’s ability to utilize structured data to enable data analytics, clinical decision support, population health management, care coordination, and patient engagement among other features and capabilities will determine the relative success and financial viability of the physician practice in the new healthcare environment.
The medical home, also known as the patient-centered medical home (PCMH), is a team based healthcare delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of improved health outcomes. The patient-centered medical home aims to strengthen the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship. The provision of medical homes may allow better access to healthcare, increased satisfaction with care, and improved health.
Care coordination is an essential component of the PCMH. Care is coordinated and/or integrated between complex healthcare systems, for example across specialists, hospitals, home health agencies, and nursing homes, and also includes the patient’s loved ones and community-based services. This coordination of care can be attained though the utilization of registries, health information technology and exchanges, and patient portals. In addition to technology, care coordination also requires appropriately trained staff to provide coordinated care through team-based models.
Partnerships between the patient, physicians and their family are an integral part of the medical home. Practices are encouraged to advocate for their patients, and at the practice level, patients and their families participate in quality improvement activities. Evidence-based medicine should guide decision making, with the use of clinical decision-support tools at the point-of-care. At the same time, patients should be involved in decision making and provide feedback to determine if their expectations are met. Physicians should engage in performance measurements to continuously gauge quality improvement. Utilization of informational technology will help ensure optimum patient care, performance measurement, patient education, and enhanced communication.
Enhanced access to care is available through open scheduling, extended hours and new options for remote care outside of the normal office visit. Importantly, payment must appropriately recognize the added value provided to patients through a patient-centered medical home. Payments should reflect the time physician and non-physician staff spend doing patient-centered care management work outside the face-to-face visit. Incentive payments should support the measurement of quality and efficiency with the use and adoption of health information technology. Enhanced communication, such as a patient portal and secure email, should also be supported. The time physicians spend using technology for the monitoring of clinical data must be valued. However, payments for care management services should not result in deduction in payments for face-to-face service. Instead, payments should recognize case mix differences in the patient population being treated within the practice. It should allow physicians to share in the savings from reduced hospitalizations, and it should allow for additional compensation for achieving measurable and continuous quality improvements.
Practice Organization
An organized practice is one that exercises disciplined financial management, creates strong and rewarding relationships between practice staff and relies on clinical systems that support the delivery of high-quality care essential to the PCMH.
Health Information Technology
A patient-centered medical home utilizes health IT to automate business and clinical processes, enable clinical decision support tools, and connect to patients and other members of the healthcare team.
Quality Measures
A PCMH will have a structured way to gather clinical data and analyze it to identify potential improvements.
Patient Experience
A patient-centered medical home is designed to enhance the patient experience, which is a transformational shift from the traditional practice that focuses on physician workflow.
Health IT plays a critical role in the successful implementation and adoption of the key features of the medical home. Health IT can support the PCMH model by collecting, storing, and managing personal health information, as well as aggregate data that can be used to improve processes and outcomes. Health IT can also support communication, clinical decision making, and patient self-management.
Adoption of the PCMH model calls for fundamental changes in the way many primary care practices operate, including adoption of health information technology (IT) both for internal processes and for connecting the practice with its patients and with other providers. Health IT has been promoted as a disruptive innovation that offers tremendous promise for transforming healthcare delivery systems, including primary care.
The Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act of 2009 (ARRA) allocated $48 billion to promote the adoption of use of health IT by eligible providers who serve patients covered by Medicare and Medicaid. In addition, the use of technology is rewarded, and in some cases required, for primary care practices to qualify to be medical homes for both public and private initiatives. As substantial investments are being made to advance both the medical home model and IT adoption, understanding how best to promote adoption of health IT in a way that fosters improved primary care delivery is important.
According to the Agency for Healthcare Research and Quality (AHRQ), "Health IT is able to support the PCMH model because of its capacity to: (1) collect, store, manage, and analyze relevant personal health information; (2) allow communication among providers, patients, and patients' care teams for care delivery and management; (3) collect, store, measure, and report on the processes and outcomes of individual and population performance and quality of care; (4) support provider's clinical decision making; and (5) inform patients about their health and medical conditions and facilitate their self-management with input from providers.
Independent physicians cannot match the large-scale investments in health information technology made by large hospital systems, so they face an existential dilemma: to either join the hospital network and lose their autonomy or risk losing patients and put the financial well-being of their practice in jeopardy.
TeamPraxis offers independent physicians a viable alternative to the hospital-centric system. Over the past 20 years, TeamPraxis has developed affordable and effective solutions for physicians to provide the highest quality care, get paid for it, and continue as independent providers.
Since 1992, TeamPraxis has been dedicated to ensuring the long-term well-being of the independent physician marketplace in Hawaii. Guided by our original vision to create a comprehensive Physician Information Network, TeamPraxis made significant investments to develop robust, future-proof infrastructure and intellectual property. The hard work accomplished over the years to persevere with our robust solution approach are now bearing fruit with the focus on quality and efficiency initiatives that structured data analysis enables. The clinical decision support and population health management functions of our Care Manager solution enable physicians to provide better quality of care for individuals and better health for populations with greater efficiency and lower costs.
Not only does TeamPraxis have a superior data-driven platform, but it also has the critical mass of physician customers built over the past 20 years. These clients now provide the foundation of real-world knowledge and experience to further develop, test and perfect analytical tools that enable physicians to collect, manage, and affect the quality measures required for them to benefit from the shift from fee for service to fee for value. Our continuing goal is to create a network of independent physicians enabled with clinical quality tools who are capable of coordinating care across a broad spectrum of healthcare providers and patients in Hawaii.
For TeamPraxis clients, demographic and claims data captured in the ConnxtMD Practice Management system and clinical data aggregated in the Enterprise EHR are scrubbed and transformed by custom developed ETLs, which store the resulting structured data in data dictionaries. The Rules Engine of TeamPraxis’ own Clinical Quality Solution (CQS) platform uses these data dictionaries to provide tools that enable clinical decision support (CDS) at the point-of-care, population health management (PHM), and the ability to create do-it-yourself analytical and reporting tools to provide the highest level of care.
The Population Health solution is a key component of the PCMH model that facilitates: (1) the clinical decision support at the point-of-care that enhances patient experience; and (2) the retrieval, monitoring, reporting and manipulation of quality measures across a population. Combined with our ConnxtMD practice management, revenue cycle management, and electronic health records products and services, TeamPraxis offers the independent physician a comprehensive solution to ensure the long-term health and financial viability of their practice that guards against the rapid changes in the industry.
Our integrated suite of solutions, developed over 20 years, enable physicians to provide the highest quality of care and get compensated for it, while staying ahead of the rapid changes in the healthcare field.
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