Leveraging a Software-Enabled-Service (SeS) Platform to Improve Clinical and Administrative Outcomes for a Practice

As medical groups feel more pressure from the government, payers and other third parties to get health information online as part of emerging performance-based reimbursement programs, many providers are challenged with how best to automate their practices and adequately participate in these programs. This session will explore how some of the country's largest academic medical groups to solo practices to emerging care deliver organizations, like retail clinical, are now leveraging software-enabled services (SeS) in order to better document and report clinical and financial data as part of performance-based reimbursement initiatives.

Jeremy Delinsky, athenahealth, Inc.

Healthcare should be about taking care of patients, began Delinsky; this simple thought certainly makes sense, but it can easily be forgotten when trying to keep a practice afloat these days. Healthcare is a challenging business to operate, with physicians (and patients) feeling the pressure from all sides, including:

• Government regulations

o HIPAA

o NPI

o ICD10

• Payers

o Lower reimbursement

o More hurdles to getting paid

o Increased “self pay” balances

• Industry

o Consumer-directed healthcare

o Retail clinicians

o P4P reporting requirements

In order to make it all work, extensive connectivity is needed, explained Delinsky. So, what plays a role in that. For starters, groundbreaking legislation was passed with the ARRA and HITECH Act, the latter tying $17.2 billion to “meaningful use” of an EHR. Meaningful us, the presenter noted, is focused on improving quality, safety, and efficiency; engaging patients and families; improving care coordination; improving population health; and ensuring privacy and security. Adoption and use are key, he added.

Proposed health reform is tied to payment reform, noted the speaker, calling attention to a quote pulled from the April 21, 2006 issue of Modern Healthcare that reads “9 out of 10 health care leaders back a ‘complete transformation of the U.S. health care system.” Adding to the argument that health reform is tied to payment reform, Delinsky presented a quote from President Barack Obama on paying for results rather than utilization: Obama said on March 24, 2009, “How are we going to reduce health costs?...Let’s invest in mechanisms that look at who’s doing a better job controlling costs while producing good quality outcomes…and let’s reimburse on the basis of improved quality, as opposed to simply how many procedures you’re doing.” Delinsky also provided a March 25, 2009 quote from Dr. David Blumenthal from the NCHIT, on changing the payment system: “Realizing the full potential of HIT depends in no small measure on changing the healthcare system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide.”

Currently, its’ too hard for physicians to get paid, expressed Delinsky, adding that there is “a mess of complex, analog-based requirements” and that “controlling the clinical workflow requires mastering a similar mess.” So, what’s a physician to do? Buy new software? Outsource billing? The speaker says doctors need a partner.

And that partner needs to be focused on results, not products, have aligned incentives (they only get paid when you do), be flexible by quickly adapting to the ever-changing healthcare landscape, and apply collective knowledge for the benefit of everyone. This partner, Delinsky feels, can come in the way of a software-enabled service, a partner that can help physicians get paid more, faster, and with less hassle.