Last week we attended the big healthcare IT confab HIMSS in that grand city of sin, Las Vegas. While many spoke of how HIMSS hit an all time record of over 37K attendees (an impressive number), HIMSS is still dwarfed by what is arguably the largest US-based healthcare trade show, RSNA, which had a 2011 attendance of just over 57K, (roughly 54% greater than HIMSS). Why such a radical difference you ask? As one colleague put it:
RSNA is where providers come to make money and HIMSS is where they go to lose money.
While that may be the case today, it is unlikely to be so in the future. The healthcare industry is undergoing a massive transformation that will likely take a decade to complete as we transition from a reimbursement model largely based on fee for service to one based on outcomes. Under this new model, providers will be taking on a greater portion of risk. In reward, these providers have an opportunity to receive a significantly higher net reimbursement. This transition is making for some interesting bedfellows as payers and providers join together to create new care delivery models such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). These new models will be increasingly dependent on a robust HIT infrastructure to effectively measure quality, risk and performance, something that simply cannot be done effectively with the antiquated systems that are in place today in many healthcare organizations (HCOs).
Nearly every vendor we met with at HIMSS had a story to tell about how they had the solution the market was seeking for ACO enablement. This was not entirely unexpected for last year we thought that would be the year of ACO. Obviously, we were a little ahead of ourselves and the industry with that prediction but alas it has come to pass. Small problem though: HIT vendors have had plenty of time to prepare their solutions for ACO enablement but to our surprise, most solutions were still far from mature. Frankly, we are not too worried about this right now for Chilmark is forecasting significant evolution, innovation, and in short-time maturity in these solutions as customers (HCOs) further define what they truly need to succeed in this new world order of reimbursement for healthcare delivery in the US.
This raises what our research team found to be the most significant learning from HIMSS’12.
As most of you already know, ONC made quite a splash at HIMSS by announcing the release of Stage 2 meaningful use (MU) requirements (we’ll have a future post on the implications of these requirements later this week). But honestly, we did not see a wild wrangling of commentary and discussion in the halls of HIMSS’12 regarding these new requirements. Maybe this was because most attendees were simply addressing the needs of today and did not have time to thoroughly review these new requirements. But we believe something else may be at work here.
Our Thesis:
The MU requirements have become little more than a “spec-sheet” for vendors, consultants and IT shops and departments. These requirements have nothing to do with innovation and have little to do with the dramatic changes that will occur in this industry in the next decade. Quoting that oft-used phrase, “follow the money” one can quickly see that the billions in funding for incentivizing providers to adopt EHRs under the HITECH Act is relative chump change to the dramatic fortunes that may be won or lost under the new value-based payment models that are proliferating throughout the industry – payment models that commonly fall under the rubric of ACO or PCMH. In each of these models, EHRs are important to a degree, they are part of the basic infrastructure. But it is what one does with the data that matters (collect, communicate, collaborate, synthesize, analyze, measure and improve). Therefore, if you want to see innovation look beyond today and the tactical push to effectively adopt and meaningfully use EHRs and towards the future of how that data will be used to drive quality improvements, better outcomes and lowering risk exposure.
And speaking of risks…
What was clearly lacking at this year’s HIMSS was patient engagement. Yes, there was a seminar on the topic and sure, everyone speaks of patient-centric care but there was little evidence among exhibitors at this year’s HIMSS (with a few exceptions, e.g., Cerner, MEDSEEK, RelayHealth) that spoke to the need to engage patients as part of the care team. Get a clue folks, one will never get to that nirvana of a truly effective ACO or PCMH without active, effective engagement of the patient. Not having an engaged patient is your greatest risk.
Could agree more on patient engagement. In light of the fact that individuals spend 99+% of their life away from providers AND what the individual does/doesn’t do will determine whether they return to or maintain their health, we don’t see how it’s possible to have success without what’s been said for a long time. That is, the most important member of the care team is the individual yet of the 100+ HealthIT systems I’ve implemented or seen, the “patient” is little more than a vessel to attach billing codes to. Redesigning those systems to be “patient-centric” will have the same result as Yahoo/MSFT et al trying to be market leaders in social networking. It’s a fundamentally different architectural design. As this KevinMD piece stated, most EMR patient portals are like driving a 747 to the grocery store – http://www.kevinmd.com/blog/2012/01/designing-friendly-patient-portal-consumers.html.
There’s an entire new ecosystem of companies (providers & tech) forming around a segment that has been patient-centered, accountable and coordinated for some years (i.e., not just talking about it). It’s the mass market version of concierge medicine known as the Direct Primary Care Medical Home or DPC for short. It has gotten far less attention than the regular PCMH but the DPC results are very, very impressive. While having customer sat ratings higher than Google or Apple, they’ve provided a very affordable offering (typically 1/3 of their patients are uninsured) that has shown to reduce the most expensive facets of care 40-80%. DPC inclusion in the insurance exchanges (even though it’s non-insurance) is one of the least analyzed pieces of the ACA which is one reason I’ve written a fair bit about them. See delicious.com/chasedave/DPCArticles for more on the model. In the last 8 weeks alone, there’s been an explosion of interest and action around these models that’s largely gone unnoticed. They provide a key to winning in the insurance exchange market.
The first wave of these DPC practices (e.g., Qliance) had to develop their own technology as the legacy healthIT systems are naturally optimized around the legacy reimbursement environment. Qliance reviewed 240 US-based EMRs before giving up on US vendors. Their aforementioned results bear out that they know what they are doing and should be a role model for the entire country given their long track record of success.
John,
This is “spot on” as the Brits would say. EHRs, HIEs, etc. are necessary but not sufficient infrastructure (i.e. important must have plumbing but not much more than that). Infrastructure alone won’t be transformative. In order to disrupt an industry business model innovation is always required. Agree that patient engagement is an important part of that. Check out a company called Info-Surge, they have an interesting story in the patient engagement space.
IncentOne would argue – and obviously this i a biased view – that the cornerstone to engagement of both of these audiences – patients and providers – is incentives. Incentives serve to unlock the value of these other infrastructure elements on the patient or provider side. Incentives drive attention and action in the engagement tools and health programs. “Follow the money” is certainly true in every other industry in which no marketer asks a consumer of services to change behavior without incentives. We believe that Incentive driven healthcare – or IDH(tm) – is the next great movement in healthcare that “folllows the money.” For anyone interested, there is an invitation only group on Linked in set up for that purpose. If anyone is interested drop me a note at mdermer@incentone.com
John,
I could not agree wit you more….. “In each of these models, EHRs are important to a degree, they are part of the basic infrastructure. But it is what one does with the data that matters”.
See my HealthBlog post from December 2009 http://blogs.msdn.com/b/healthblog/archive/2009/12/10/it-s-what-you-do-next-with-your-emr.aspx
Bill Crounse, MD
As our friend @epatientdave always says… let patients help … it was a glaring absence… although the comments from the Aetna CEO are somewhat encouraging.
John – Have a look at Avado’s Patient Relationship Management system. I think it’s what you have in mind when you think beyond EHRs and HIEs to really get patients engaged. They have a very different take on it. IMHO… it’s well worth looking into and the physicians I have spoken to who are using it are quite pleased with the UI/functionality etc. Dave Chase and his team have executed well.