The Ramification for IT and New Models of Care and Payment Reform

The historical fee-for-service model of health care services in the United States has long been considered a contributor to cost and quality problems; constituting more of a disease care system as opposed to a health care system. In an effort the replace this fee-for-service model, various new forms of payment and models of care are being explored around the Country. Wagner, Lee and Glaser classify the various new forms of payment as: bundled payments, pay for performance, shared savings programs, capitation or global payment, and episode of care payments. As one can imagine, the changing landscape of health care payments, coupled with CMS sponsored new models of care, with Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), have a monumental impact on the health care IT ecosystem.

The new models of care and payment reforms all tend to all focus around integrated patient care, or a continuum of care. For this continuum to thrive, it is critical each member of the health care team be able to share information with the other members, throughout the care process. Health care coordination means the right care in the right place at the right time by the right provider - all the time. To manifest properly, this requires health care organizations achieve efficiencies in service and cost by monitoring for safety and controlling quality; using evidence based practice guidelines; and providing the tools to constantly strive for improvement. The interoperability of health care information systems, connected to corporate accounting and finance systems, all play a vital role in this continuum of care. A recent study shows the PCMH and ACO initiatives, together with IT, are having a clear impact. “Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing [population management, quality measurement, patient communication, and care coordination.]” (King, Patel, Jamoom, DesRoches. 2016)

The ability to connect various health care information systems together across different organizations, requires the ability for the various systems to uniquely identify patients. The creation of master patient indices is an important first step in enabling the interoperability of various health care informations systems. Patient indices allow the linkage between various medical record numbers or patient identifiers, across the organizations. In many instances, a record locator service may be utilized to determine which patient records exist and where to find them. Some of the key services that record locator services provide are: The management of identifiers for participating providers; Maintaining and publishing a patient index; Matching patients using defined algorithms; Looking up patient record locations; Managing patient consent for sharing of records; And finally, it is important the record locator service offer secure communications and an audit log.

Cost management requires the leadership at health care organizations, have the proper tools and data to support the various types of payment models. Having proper cost control and accounting software, is as important as having proper electronic health record systems, to effectively manage the divergent payment models. Interoperability between the various systems is crucial to ensure the executives obtain accurate, timely and actionable information. Additional IT systems, like home care monitoring systems or patient portals, and other engagement tools are also needed to monitor patient information, and more actively engage the patient in the management of the own health care.

The ramifications for IT, from the new models of health care and payment reforms, are vast. The new models focus on the continuum of care, and require interconnected health information systems, to allow all the providers, to share information throughout the entire health care process. Such systems, interconnected with finance and account systems, assist with the organization's leadership decision making. The creation of master patient indices, with record locator services, impact IT by definition, and greatly assist in the move toward integrated care, and a closer adherence to evidence based practice guidelines.

Wager, K. A., Lee, F. W., Glaser, J. P. (2009). Health care information systems: A practical approach for health care management. San Francisco, CA: Jossey-Bass.

King, J., Patel, V., Jamoom, E., & DesRoches, C. (2016, April 15). The Role of Health IT and Delivery System Reform in Facilitating Advanced Care Delivery. Retrieved November 6, 2016, from http://www.ajmc.com/journals/issue/2016/2016-vol22-n4/the-role-of-health-it-and-delivery-systemreform-in-facilitating-advanced-care-delivery