Kris Zierolf, Director, IT Revenue Cycle, Renown Health
Government regulation, changing customer demand, and technological advances are redefining what it means to provide quality healthcare; and IT is being required to fill the dual role of customer service and steward of technology infrastructure. As healthcare reinvents itself as a vast array of services, clinicians, and technology, IT departments are being called to innovate, develop, and keep systems stable and ready to adapt to new initiatives. Many organizations find themselves in a post-EMR era with EMR optimization and integration placing continued demand for IT resources. Managing initiatives in a piecemeal fashion will become increasingly ineffective. It is time to look to the non-technological forces that will change healthcare organizations’ ability to succeed or fail. The new healthcare IT will be forged by regulatory and social forces.
“A true partnership between IT and operations will continue great service and add understanding and accountability”
Regulation and Legislation
Last year, we watched as the Centers for Medicare & Medicaid Services continued to transition reimbursement from fee-for-service to quality-based models. This investment in alternative payment models such as Accountable Care Organizations, advanced medical homes, and bundled payments for episodes of care seeks to have 90 percent of Medicare payments linked to quality by 2018. Most health organizations have been preparing for this through continuations of existing programs and a focus on patient-centric care. What HIT leaders need to be ready for is possible changes under a new administration and its focus on 'repealing and replacing' the Affordable Care Act, the evolution of MACRA legislation—which will likely remain in some form—and changes to state law. The potential for disruption to the regulatory landscape, for good or bad, is real and we must prepare teams now.
For IT to accelerate and not hinder regulatory adoption we must shed the paradigm of a customer service department. While great customer service is a cornerstone in solid organizations, customer service implies “the customer is always right” and this mentality is dangerous when we must ensure the security of patient data, maintain stable operating environments and be nimble enough to confront new changes in technology. A true partnership between IT and operations will continue great service and add understanding and accountability. To be successful, IT organizations need to develop a knowledge base that understands the technology in play and why it is in use.
The risks of failing to partner are real; increased delay in implementation, non-agile iterative build, and the failure to innovate because the objective is unclear. Regulatory changes are often reacted to and by nature not planned for, leaving a gap in resource planning and commitment. Without knowing the goals and challenges of its partners, not even a superior development team can create anything of lasting value.
Demand, Consumption and Social Pressure
As healthcare organizations focus on quality, filling care gaps, and managing patient transitions of care, the patient’s role is also changing. Patients are becoming more educated in the management of their health. They are looking at data to ensure their hospital is highly rated, their doctor has good reviews, and that they will get the best quality for their dollar. Patients are demanding estimates upfront, want better explanations of insurance coverage, and continue to question costs. While price transparency has been a hot topic in healthcare for years, despite a relatively low percentage of consumer 'shoppable' services, the projected increase in healthcare costs will continue to generate more demands for transparency. Patients on employer-sponsored plans may continue to see a rise in premiums coming from their paychecks as well as increased out-of-pocket costs. With the medical cost growth rate expected to remain close to the current rate there will be increased demand from customers and employers to quickly find the lowest cost care. The fact that customers want low cost, high-quality care is not surprising. What is changing is that in addition to the usual demands, patients also want access in modes of greater convenience. Healthcare as a service is being demanded, the communities we support that have adopted the mobile/social lifestyle, want cloud-based or mobile everything.
Patients will continue to request care through new technology. The organizations that rise to the challenge will thrive. Organizations that ignore these trends do so at their peril. To resolve calls for convenience, telehealth services, wearable technology, and physician house call initiatives are gaining traction and each bringing with it numerous technical challenges. To meet those challenges IT will need to develop non-traditional expertise and be mobile. Without investment in technology and human resources development in newly adopted technology it will be increasingly difficult to quickly deliver services and ensure connectivity and quality is the same remotely as it is in-person. To do this well, new deployment methodology, increased adoption in virtualization and continued investment in telehealth, remote monitoring, home delivery, and mobile applications for both clinician and patient will be needed. Having a unified portal and engagement strategy that supports the efforts of care delivery, revenue cycle, population health management, and marketing will be critical. At the core of these endeavors is the need for data. To have the best possible outcomes you need precision data and solutions that turn information into insight. CIO’s and HIT professionals will be increasingly engaged developing ways to use information systems to provide greater error proofing, real-time decision support, and leverage data to make meaningful connections regarding patient health.
We are in a point of transition. Modes of care continue to migrate into the community. The prologue of an uncertain regulatory future has been written and new technology and customer demands are changing weekly. To support and survive this transition we cannot assume that we can adapt organically to all of the new demands for technology. A focused strategy of deployment that has buy-in at the highest levels will be needed to keep organizational leaders from fighting over limited IT resources and remaining focused on development of the high-quality, modern applications that are needed.