Issuu on Google+

Need for Connectivity, Data, Collaboration Here to Stay | connect.curaspan.com

1/4/12 11:39 AM

Need for Connectivity, Data, Collaboration Here to Stay by John Rossheim Whatever the U.S. Supreme Court decides this year about the Affordable Care Act, some activities started or intensified because of the 2010 reform law will continue, according to industry insiders and observers. Driven by powerful economic forces, providers and payers will try to keep up momentum toward two goals: Integrate care and boost the electronic exchange of health data. “The pillars of the bill are just reasonable changes that should go ahead anyway,” says Daniel Fass, M.D., a radiation oncologist in Rye, N.Y., who advocates for health-care reform through Doctors for America, an organization of physicians and medical students promoting universal access to health care. The pillars of the ACA include coverage of pre-existing conditions, expansion of insurance to millions more Americans, and reimbursement of providers for quality of outcomes rather than quantity of services rendered. The bottom line for health-care professionals: Reform’s diverse stakeholders can continue to pursue these goals, confident that their efforts aren’t likely being made moot by action in the courts or Congress. Still, the demise or decimation of the ACA could slow these trends or limit their scope. Price Pressure Will Continue. With budgets under stress and health-care spending at 18 percent of the U.S. economy and rising, the drive to deliver more cost-effective medical care across the continuum won’t let up, regardless of the fate of the reform law. “Price pressure will continue,” says Dr. Fass. “There’s a lot of pushback, and it’s growing. Everyone has to be more efficient if they want to be a winner.” The impetus for cost containment has many sources, from employers reluctant to pass on premium increases to insurers who face increasingly angry opposition to rate increases. “Payers are coming back to providers and saying, ‘We’re no longer willing to subsidize what Medicare won’t pay you,’ ” says Jason Greis, an attorney with McGuireWoods LLP in Chicago. “So rates are getting compressed a lot, and this will persist,” regardless of the fate of the ACA. Integrated Care Models Won’t Lose Momentum. With large health-care systems striving to get ahead of ACA mandates that reward quality of outcomes over quantity of services provided, efforts to define and institutionalize accountable care are picking up, if only at a limited number of large hospital systems for now. “Conversations around ACOs and medical homes have motivated the private sector to try to make care delivery work better,” says Joseph Berardo, president of MagnaCare, a health-plan services administrator in New York and New Jersey. “Even if ACA falls, it won’t stop the movement toward consolidating hospitals,” says Robert Cimasi, president of Health Capital Consultants in St. Louis. For example, financially strapped “smaller community hospitals will look for affiliations with regional institutions.” With nurses and primary-care physicians in chronic shortage, some liken the situation to a land grab. “Payers are buying physician practices to control costs, and hospitals that are eager to protect their reimbursements are beginning to set up ACOs with their physicians,” says Andrew Selesnick, head of the health-care law group at Michelman & Robinson LLP in Los Angeles. Some stakeholders are considering novel business models for integrated-care systems that increase revenue, regardless of what happens with ACA. Says Berardo, “Providers are beginning to organize themselves into products, thinking ‘We’ve got three hospitals, 2,000 doctors, surgicenters – why don’t we bring this directly to employers?’ ”

http://connect.curaspan.com/articles/need-connectivity-data-colla…onjHpfsX+4+orXbHr08Yy0EZ5VunJEUWy2YYITNQhcOuuEwcWGog8wxlKG/OFfY4=

Page 1 of 2


Need for Connectivity, Data, Collaboration Here to Stay | connect.curaspan.com

1/4/12 11:39 AM

Business Needs Underscore Need for Connectivity. The heavy lifting on infrastructure for community and regional-scale health data exchanges can continue no matter what the court does, according to Eric Mueller, president of WPC Services, a health-care technology consultancy in Brentwood, Tenn. “HIEs that solve fundamental business problems for payers and providers will be successful,” he says. “Focus on data points you know will be relevant, like HIPAA 5010, clinical EDI, HL7 and pharmacy data exchange,” he says. “These and some others get you 80 percent there.” Absent the ACA and a government-funded mandate for HIEs, the success of efforts to deploy data exchanges widely would ultimately depend on the transparency of the return on private investment. “A continued push for HIEs makes tremendous sense, because providers can see the savings in their offices, and the clinicians can see more patients,” says Selesnick. John Rossheim is a writer and editor who covers information technology, careers and other topics in health care. Related Links: > Synchronized Patient Management™ > Hospitals, Payers Seek Certainty on ACA > The Elegance of Workflow Automation > Riverside Health System Knocks Down IT Silos, Builds New Model of Care Facilitation

http://connect.curaspan.com/articles/need-connectivity-data-colla…onjHpfsX+4+orXbHr08Yy0EZ5VunJEUWy2YYITNQhcOuuEwcWGog8wxlKG/OFfY4=

Page 2 of 2


January 2012 Curaspan Connections - Need for Connectivity, Data, Collaboration Here to Stay