Provider Perspectives Research
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The document outlines significant changes in the healthcare landscape due to reforms such as the Affordable Care Act and the 21st Century Cures Act, emphasizing the shift towards interoperability, value-based care models, and patient engagement. It highlights the necessity for healthcare IT advancements to meet new compliance and operational efficiency demands, as well as the challenges faced by providers in adapting to these changes. Ultimately, the document underscores the importance of technology in delivering better patient outcomes while controlling costs in a rapidly evolving industry.
Provider Perspectives Research
- 1. 1 Provider Perspectives June 2021 Sidney Kanell & Kapil Desai
- 2. 2 An Evolving Regulatory Landscape The last decade of healthcare reform has significantly shifted how healthcare is delivered, documented and reimbursed American Recovery and Reinvestment Act (ARRA) & Health Information Technology for Economic and Clinical Health (HITECH) Act Affordable Care Act (ACA) Health Level Seven International (HL7) adopts Fast Healthcare Interoperability Resource (FHIR) ONC & CMS cite FHIR in Cures Act Final Rule Medicare Access and CHIP Reauthorization Act (MACRA) 21st Century Cures Act (Cures Act) • Invests in healthcare IT and incentivizes providers to adopt EHRs • Gives patients the right to obtain their information in an electronic format • Broadens insurance access • Increases consumer protections and expands the health workforce • Encourages ACOs (provider groups that coordinate on care) • HL7 is an organization that establishes standards for the transfer of health data • FHIR is a standard for data and APIs which promotes interoperability • Implements interoperability and patient access rules introduced by the Cures Act • Prevents information blocking • Requires FHIR Compliance • Bipartisan support to mandate the transition from fee-for-service (FFS) to risk-based payment models • No more FFS reimbursement increases • Aims to accelerate medical innovations and improve patient experience • Advances interoperability and addresses data blocking 2009 2010 2011 2015 2016 2020
- 3. 3 $0.0 $0.5 $1.0 $1.5 $2.0 $2.5 $3.0 $3.5 $4.0 1960 1968 1977 1985 1994 2002 2011 2019 Cost as a Catalyst for Change New care delivery models emerge as stakeholders across the ecosystem seek opportunities to reduce costs Total National Healthcare Expenditures ($T) $3.8T Employers increasingly opt for self-insurance, bearing more of the risk themselves in order to avoid paying high fees and premiums to an insurance carrier • 67% of U.S. workers are covered by self-insured employers as of 2020 Payers embrace alternative reimbursement models • Commercial insurers are motivated to adopt value-based care (VBC) models in order to reduce costs and attract / retain employer contracts Direct primary care practices have become more popular due to rising premiums and out-of-pocket expenses • Rather than go through insurance, patients can pay a monthly subscription for basic primary care services Source: https://www.cms.gov/
- 4. 4 Stages of Healthcare IT Healthcare IT 1.0 – Digital The introduction of EHRs began the digitization of healthcare information Healthcare IT 2.0 – Efficient Efficiency tools automate practice operations and establish lines of communication between providers and patients Healthcare IT 3.0 – Proactive Information sharing and improved patient engagement enable a data-driven, proactive approach to patient care Healthcare IT solutions have blossomed as a result of healthcare reform, rising costs and the broader consumerization of healthcare
- 5. 5 Powering the Shift from HCIT 2.0 to HCIT 3.0 • Interoperability – Meet new information sharing requirements; attract / retain patients; leverage best of breed technology through APIs • Patient Engagement – Promote collaboration between the patient and entire care team; activate patients; improve patient satisfaction and outcomes • Value-Based Care – Hit quality metrics; get the right care at the right time to the right patient and benefit from the shared savings • Operational Efficiency – Reduce administrative burden; adapt to an evolving payer landscape; shift focus to patients over operations Interoperability Patient Engagement Operational Efficiency Value-Based Care
- 6. 6 Interoperability gives patients control of their data and arms providers with the information they need to deliver quality care; health data is increasingly accessible to patients via apps and portals and to providers via external systems powered by FHIR APIs New interoperability standards go into effect as we cross Cures Act Final Rule implementation deadlines, requiring providers to participate in information sharing • Providers feel unprepared to comply with new standards due to tech deficiencies; a HCIT refresh will enable doctors to connect via APIs in order to send and receive data and notifications • Information security is at the center of HIPAA-compliant information sharing, placing an increased focus on cybersecurity • Data standardization remains an obstacle; providers need technology that allows them to record, send and receive data in a sharable format When providers embrace interoperability, they unlock insights that help them grow their business and offer higher quality care • Helps eliminate duplicative and sometimes unnecessary procedures and supports successful Remote Patient Monitoring (RPM) • With increased data liquidity, the focus shifts to distilling the most important information; predictive modeling can help providers determine the most relevant data points to inform the best course of care Interoperability
- 7. 7 Patient Engagement Patients demand more time and attention from their providers • Telehealth enables more consistent and time-efficient patient interactions • Practices leverage their non-doctor staff to manage patient relationships and maintain an open line of communication • Asynchronous communication increases patient activation and improves patient outcomes Since interoperability gives patients direct access to their health data, it becomes easier for them to switch providers; therefore, patient experience and satisfaction are increasingly important competitive advantages • Price and quality transparency empower patients to choose providers that best fit their needs • Patient engagement platforms streamline appointment scheduling and paperwork which results in a better intake and follow-up experience • Integration with consumer wearables enables RPM and proactive treatment plans in order to achieve better health outcomes • Tools that facilitate patient segmentation help providers identify individual preferences and create curated care plans Ongoing patient engagement ultimately results in superior health outcomes and improved patient retention
- 8. 8 40% 30% 25% 25% 20% 30% 15% 15% 2021 2022 Improvement Activities Cost / Resource Use Promoting Interoperability Quality VBC is intended to improve patient outcomes while simultaneously driving down the cost of care; however, misaligned incentives have stalled its adoption since providers have historically struggled to receive bonuses through VBC • RPM and patient engagement tools facilitate proactive, preventative care in order to (i) control costs, (ii) improve clinical outcomes and (iii) achieve high scores on quality metrics, all of which ultimately result in higher reimbursement • Care team coordination and high-quality referral networks empower providers to retain patients in network • Aligning incentives between patients, providers and payers will unlock the potential for better collaboration and innovation across the healthcare ecosystem Value-Based Care As (i) CMS’s penalties for not participating increase, (ii) no-financial-risk periods roll off and (iii) commercial insurers increasingly implement value-based reimbursement programs, providers must leverage technology in order to achieve success under VBC 4% 5% 7% 9% 2019 2020 2021 2022+ Maximum MIPS Penalty / Reward by Payment Year MIPS Performance Metrics By VBC Score Contribution Note: Payments are based on performance from two years prior.
- 9. 9 Direct Clinical Patient Care EHR / Desk Work Administrative / Other The industry is due for an EHR refresh cycle; rigid legacy EHRs have poor UI/UX (too many clicks) and providers end up spending more time charting a visit than they spend with their patients • Modern EHRs must support apps and integrations including patient engagement tools, telehealth, practice management systems and billing systems that support new payment models • Voice recognition tools will help reduce charting and other manual data entry • EHRs that accommodate changing reimbursement models help doctors (i) come up to speed on relevant changes and (ii) meet the appropriate metrics in order to achieve financial success under any alternative payment model • Solutions that automate / facilitate payments based on coverage and reimbursement model will help reduce the number of unpaid bills and aging receivables from both patients and payers, a major pain point for most providers Operational Efficiency Modern tech stacks should reduce administrative burden and must be flexible in order to accommodate the evolving payer and regulatory landscapes; best-in-class solutions should be “built by doctors for doctors” unlike many legacy systems Where Doctors Spend Their Time Source: https://pubmed.ncbi.nlm.nih.gov/27595430/ (2016)
- 10. 10 Provider Solutions Market Map Interoperability Patient Engagement Value-Based Care Operational Efficiency
- 11. 11 Please send any inquiries to sidney@catalyst.com