Inaugurating Health Care Reform: Will the EHR Crack the Crisis in Health Care? (Part I-h)

March 3, 2009

Comprehensive Managed Care in 2010

Will the EHR Crack the Crisis in Health Care?

The Promise of Digital

I don't think the matter of moving health care into the digital age, ie, "Health 2.0, Health 3.0, and Beyond …" will depend upon patients or physicians in the short run and neither do the MDNG Editors.

• In "One Last Look back: The 10 Biggest Health IT Stories of 2008," subtopic: "The Case for Aggregating Health Data around Patients," the columnist says: "I’ve come to believe that developing a digital network providing for the free, bidirectional flow of health information between every physician, hospital, clinic, pharmacy, laboratory, imaging center, insurance plan, and everything else in the ecosystem just isn’t feasible at scale. Even if the technology existed to do this, the money certainly does not, and furthermore, there’s no business model to support the exchange of information between competing physicians, hospitals, and clinics."

• Further, the MDNG January 2009 cover story—"Where Do We Go from Here? A Health 2.0 Progress Report" has the author saying there are no emerging leaders for the digitalization of health care. That comes as no surprise; there's no viable business strategy in the offing and privacy concerns are daunting. It seems like another "What's in the Stimulus Package to Get Us Moving" debacle.

There is, however, at least one way to financially support the computerization of health care and thereby health care reform (and no, I am not referring to selling scrubbed data or pushing paid advertising).

We learned (the hard way) in the hay day of managed care that one could not manage that which one failed to measure; the reverse was/is true as well. Nevertheless, it is that very dictum that will catalyze health care into the digital age.

But First, Unavoidable, Disappointing Results Managing Chronic Disease in Medicare?

"Sobering Results for Cost-Cutting Medicare Project": AP Feb 11, 2009

Caveat: Because patients vary in their genetic burden of risk, lifestyle choices, stress levels, the consequences of the vicissitudes of life (the hand they are dealt), and because they don't always adhere to doctors' recommendations (even when such are perfect), to be fair, outcomes data should be acuity-adjusted, incremental and yet based upon a full episode of care. Also note that at this point, we are not necessarily insisting on a computerized patient record. Encounter/billing data can be analyzed, but clearly, outcome measurement is critical; cost-effectiveness information is vital to glean; acuity-adjustment is a must; and, emphasis on primary care is a given. Cost sharing with patients is also important, though it should not be a barrier to access.

I believe that that disappointing scenario does not have to be. When I was a Chief Medical Information Officer and Medical Director for the New Alliance Health Plan (Erie, PA) in 2000, we used constructive feedback to realign incentives and we improved both outcomes by and reimbursement to participating doctors thereby. The point is that once the feedback loop is closed, not only will patients have the best chance for optimal care—when they need it, where they need it, and by the right practitioners, but also those practitioners may be aptly paid. That's the kind of reform that is a win-win for everyone concerned.

"An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work, a government-contracted study found. The disappointing results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many different doctors and sometimes get conflicting medical advice."

Reader: Why didn't the Medicare effort in chronic disease management work well? BecauseA. Doctors are too antonymous? B. Patients are 'hell bent on self-destruction' or they simply don't listen? C. Health care needs better coordination? D. Doctors are paid incorrectly given the task at hand—health care reform? E. All the above

For further discussion, please see next week’s post.