There's great excitement and much debate over President Obama's ambitious healthcare reform agenda. Unfortunately, its three major thrusts--adoption of health information technology (HIT), universal access, and payment reform--focus only on improved access. Policy makers are realizing that these initiatives will only lead to cost increases and magnify healthcare labor shortages.

Joseph C. Kvedar, Contributor

August 18, 2009

4 Min Read

There's great excitement and much debate over President Obama's ambitious healthcare reform agenda. Unfortunately, its three major thrusts--adoption of health information technology (HIT), universal access, and payment reform--focus only on improved access. Policy makers are realizing that these initiatives will only lead to cost increases and magnify healthcare labor shortages.Payment reform will be a catalyst to transform our broken health care system, but without a more well-rounded HIT strategy, providers won't have the tools to truly move to the population-based, health-oriented system that policy makers envision. Likewise, our society needs to adopt a much more health-oriented culture, and that, too, will require fundamental shifts.

The reform package places too much emphasis on increasing access to care through universal coverage and to traditional HIT, such as electronic medical records (EMRs). I'd like a more patient-centric approach that includes incentives for providers to adopt population health management tools and for patients to take ownership of their health.

At the Center for Connected Health, we believe the solution lies in the use of technologies, predominantly messaging and monitoring tools that can extend care to patients, wherever they are and whenever they need it. Just as important, such tools can be used to enable patients to be their own primary care providers whenever possible. Physician EMR adoption isn't the complete solution. Rather, another set of tools is required--ones that encourage this vision of connected health.

The Obama Administration's emphasis on extending access and implementing EMRs is laudable and likely to have a positive impact on both access to and quality of healthcare. But both initiatives have a good chance of negatively impacting efficiency.

EMRs support current workflow and reimbursement models, which are tragically flawed and provide no incentive to rein in costs. They also support another outdated model: making the provider responsibility for the patient's health, eliminating any patient accountability.

To improve efficiency, I suggest a more aggressive implementation of two initiatives buried in the fine print of the current reform discussion.

First, we need to change our fee-for-service reimbursement model into one that focuses payment on high quality and better population management. Outcome-focused reimbursement should align payer and provider incentives. The good news is that there's some discussion of bundled payments coming out of Washington. Bundled payments refer to a system where a patient's care is paid for in a lump sum over a period of time, and those payments are usually divided into a base payment and bonuses for achieving quality metrics. I'd like to see that more front and center.

The second suggestion is to create incentives for the adoption of population health management tools and strategies, such as care coordination, the patient-centered medical home, the use of patient registries, and case management. This would marry nicely with payment reform and result in a true transformation of our healthcare system, as opposed to incremental innovation. However, to find reference to this, you have to go deep into the proposed implementation of HITECH and the definition of meaningful use. The vision is there, but I'd like to see it more prominent.

Work done at the Center for Connected Health has borne out the value creating such incentives:

Giving congestive heart failure patients a simple set of technologies and some coaching can keep them out of hospitals and emergency rooms, saving tens of thousands of dollars per avoided admission. A text message can improve patients' adherence to medication routines from 20% to 60%. A smart pedometer coupled with an educational Web site can result in improved activity management in 10% of the population. Daily tracking of glucose readings in a diabetic patients can lead to insights on how both patients and providers can improve disease management, avoiding costly care down the line. Payment reform that emphasizes quality and population health management strategies that feature connected health initiatives would both be powerful additions to the healthcare reform package. Dr. Joseph C. Kvedar is the director of the Center for Connected Health, a division of Partners HealthCare in Boston. Connected Health is focused on developing new methods of delivering quality patient care outside traditional medical settings.

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