The challenges of the healthcare industry's transition to accountable care are on the minds of most medical professionals.
Now that the concept of value-based care is being discussed widely in healthcare, companies in both the public and private sectors are helping to drive the transformation in the healthcare system. The formation of the Health Care Transformation Task Force in January 2015 has indicated a drive among stakeholders to encourage innovation in aiding the industry through a transition period.
However, there are many facets and stakeholders in the transition with a variety of concerns. In a recent webinar hosted by Becker's Hospital Review and sponsored by Care Innovations, an Intel-GE joint venture company that has developed remote care monitoring and sensor analytics as well as patient engagement solutions, Care Innovations CEO Sean Slovenski was joined by Chris Dawe, the managing director of policy and transformation at Arlington, Va.-based Evolent Health, Mitch Higashi, chief economist at GE Healthcare, and Laurie Orlov, founder of Aging in Place Technology Watch, a market research firm that follows technology that will better enable the elderly to continue living in their home of choice, in a discussion about the transition to accountable care.
Mr. Dawe said that because 169 million people, nearly half the U.S. population, are expected to be under a material provider risk-bearing payment structure by 2018, the need for payment reform is driving innovation in the private sector as well as the public one. He is involved with the Health Care Transformation Task Force and said one of the goals was to send a private sector-based market signal that this is significant.
"There are many factors that are driving transformation in healthcare that make it the most dynamic industry in the world right now," Mr. Dawe said. "Technology, regulation, innovation- those are forces that have changed other industries."
Most of the industry was galvanized to action by HHS Secretary Sylvia M. Burwell's January announcement of CMS' commitment to value-based payment structures, he said. The task force formed in response, with each company making a commitment to shift 75 percent of its business to value-based models. The coalition as a whole committed to designing programs that provide reasonable returns to deliver the triple aim of healthcare reformation—better care and improved outcomes at a lower cost—as well as equipping market players with all the tools necessary to compete, encouraging multi-payer participation, sharing cost savings and fostering transparency while supporting the needs to participants, he said.
The healthcare system has multiple facets that must be addressed during this transition, though, one of which is declining hospital margins, Mr. Higashi said. Many hospital executives are concerned about increasing regulation as they watch their reimbursements decline, worried about how they will maintain their operation while meeting the regulatory requirements, he said.
"When we talk with executives and administrators, this common theme keeps arising: 'How do I keep patients out of the hospital and keep the lights on inside?'" Mr. Higashi said. "We are still one foot in the world of fee-for-service. We call this the new paradox, and we think this is going to be prominent in decision makers' minds."
An economy of outpatient and complementary services has grown up around hospitals, helping patients stay out of the hospital but simultaneously tapping into a hospital's revenue stream, he said. Hospital administrators must rise to meet the challenges, as consumers are increasingly open to digitally-driving diagnosis and treatment options as well as being open to new option for common procedures, he said. The changing behavior of consumers will aid the healthcare industry through the transition to focusing on value instead of fee-for-service, he said.
The introduction of technology can help the industry cross the bridge, he said. Other industries have experienced significant workforce automation after the introduction of technology, but healthcare has largely remained the same. However, at the same time, productivity per employee has not risen as the workforce has expanded, making healthcare inefficient and oversized, he said.
"When you are tasked with keeping patients out of the hospital, you need to closely monitor the costs and report quality measures," Mr. Higashi said. "We think there is going to be a large need to underpin this with health IT. The healthcare IT of today is a digitization of paper records. We think tomorrow it will be something else."
Ms. Orlov said one of these opportunities will be in the relocation of long-term care. Most elderly people are required to leave their homes eventually for care, but the digitization of patient monitoring and other technologies such as telehealth and wearable technology will give those patients a better connection to a healthcare facility when they need it, she said. As the population ages, this need will become greater, especially the need to improve overall quality of life in old age, she said.
"With higher quality of life, those people will likely be healthier longer and will not need the intensive care, and the safety and security technologies will allow them to live at home," Ms. Orlov said.
Some are concerned that older patients may not take to new technologies, but Mr. Slovenski said the increasing development of technology appeals to human psychology so it is more appealing to everyone, not just the technologically savvy.
"Companies are starting to understand that they need to understand people better and what motivates them," Mr. Slovenski said.
Although there have been objections to the details of the plan to transition to accountable are, many physician groups are beginning to embrace it and join into the task forces reimagining the reimbursement models. Mr. Higashi said their input on policy recommendations could help shape clinical practice and cost strategies in the medical field. Mr. Dawe agreed, saying that the recent Medical Sustainable Growth Rate bill had support from most physician societies. The transition to accountable care is also in line with the mission of their field—to care for people in the best way possible, he said.
"At a policy level, that is something that is broadly supported in the physician community," Mr. Dawe said. "At a high policy level, it seems pretty clear that the physician community feels this is a good thing."
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