The state of healthcare in the U.S. is changing dramatically.
This may not be surprising. After hearing terms like “population health”, “Obamacare” and “death panels” (yikes!) thrown around for the last few years, you must have known something was going on. While there are many changes afoot, in this post I want to discuss one specific area of healthcare that's currently in flux; payments. I’ll also point out how one provider is innovating to provide better care to their patients at a lower cost.
For decades, the United States healthcare system has operated on a fee-for-service payment model, where healthcare providers are paid a fee for each visit, test, or procedure.
For example, let's say someone is admitted to their local hospital for a surgical procedure which requires them to be admitted for three days. This admission will include everything from pre-op consults through to surgery and recovery. The payer (usually an insurance company) would be billed by the hospital for each individual part of that admission, from the surgeon’s fee, to anesthesia, to the meals the patient is served. That’s “fee-for-service” billing.
This has been the main billing model for U.S. healthcare providers for many years. And over that time, it has contributed to rising healthcare costs tremendously.
That’s because with fee-for-service billing, healthcare providers are incentivized based on the quantity of services provided, rather than the quality of those services (as well as the ultimate patient outcomes). Not only has there not been any incentive for doctors to abstain from unnecessary services or consider the cost of treatments into their decisions, thanks to our litigious society, the risk of doctors being sued for medical malpractice actually incentivizes providers to prescribe more tests and procedures. Each of these increases the cost of care for that particular episode and may or may not actually improve patient health.
While unsustainable healthcare costs are bad news, the good news is that our country has taken notice. New laws and regulations and increased pressure from Medicare for new payment approaches are driving a paradigm shift in U.S. healthcare.
This shift is slowly taking us away from oversubscribing expensive services and towards solutions that deliver more value to the patient at a reasonable cost. This approach, typically called “value-based care”, is different than what the U.S. healthcare system is used to, and it requires collaboration and innovation to be successful.
During this time of change, some providers are stepping up to provide innovative solutions to help address patient health in a new way. One such provider is Dartmouth-Hitchcock, an academic medical center based in New Hampshire.
This year, Dartmouth-Hitchcock partnered with Microsoft to launch ImagineCare, a new platform that revolutionizes the delivery of healthcare, especially for those managing a chronic condition. ImagineCare leverages wearable technologies with remote sensors to gather real-time data; keeping patients in constant communication with their care teams.
For example, managing hypertension is typically a lifelong challenge. Taking medication, getting regular exercise and monitoring your blood pressure are critical to your ability to stay healthy and avoid serious health risks. For a patient in this situation, ImagineCare would provide connected devices like a blood pressure cuff, scale, and activity tracker. When the patient weighs in on the scale, goes for a walk with the activity tracker, or takes their blood pressure with the cuff, that data is transmitted via the cloud to ImagineCare’s staff of licensed medical professionals, who monitor the patient’s health and are available 24/7 for consultation.
There’s also an ImagineCare mobile app, so that patients can access their own integrated health information and receive important reminders, like upcoming appointments or when to take medication.
With ImagineCare, Dartmouth-Hitchcock has found a way to empower patients to better manage their own care, improve overall population health, and (using the latest technology) reduce the cost of providing great healthcare.
So how does it work?
ImagineCare is a sophisticated technology platform that integrates important health information from a variety of sources. That data is then assembled into trends and charts to illustrate how the patient’s health is tracking. This reporting is made available to ImagineCare staff and to the patient. Finally, new data collected by ImagineCare is integrated with Epic, an Electronic Health Record (EHR) software used by Dartmouth-Hitchcock and other providers, to keep the patient’s health information up-to-date.
With all of those moving parts, the ImagineCare team had two specific challenges to solve for:
- Securely communicating back and forth with complicated EHR platforms to keep patient data current
- Keeping ImagineCare medical staff notified of important patient events, especially admissions, discharges, and transfers
To address these issues, ImagineCare enlisted the help of Modea.
Much of ImagineCare’s data is hosted in the cloud using Microsoft Azure. In order to easily integrate with Epic, ImagineCare utilized Redox, a healthcare application programming interface (API) ideal for integrating with EHRs (such as Epic).
ImagineCare partnered with Modea to develop and integrate APIs to request and push patient data back and forth between EHRs and ImagineCare. This way, important patient data, such as health information collected by wearables, can be shared across both the ImagineCare platform and Epic as the EHR. This gives the entire care team a more complete picture of the patient’s overall health.
Additionally, when a patient is admitted, discharged, or transferred (ADT) from a provider location, the information is logged and pushed to the patient’s EHR. When information is logged during the ADT process, another request is made looking for any new information on the patient’s Electronic Health Record.
ImagineCare represents a big step forward in digital population health management. Through these integrated APIs, data can successfully pass through the necessary channels at the necessary times, ensuring patients, doctors, and ImagineCare staff all have consistent information to provide a more holistic view of the patient's health.
This ability to integrate and view information gets patients more engaged in their own care through aggregation and analysis of data captured across multiple healthcare systems and technologies. Providers can also make more informed decisions about patient care, ultimately increasing value and improving clinical and financial outcomes.
ImagineCare is truly a leader in the shift towards sustainable health care and population health management.