Federal Policies and Initiatives - Health Informatics in the Cloud - page 16

a well known and respected health system in Wisconsin, was the most successful
site and earned more than half of the performance payments. Dr. Theodore Praxel,
who headed the Marshfield effort, attributed their success in part to “health informa-
tion technology (point-of-care reminders, being completely chartless)”.
A report on this project by the Commonwealth Fund states that:
“All of the sites participating in the PGP Demonstration have introduced some
form of information technology that makes clinical data more readily available at
the point of care, including EHRs and patient registries. This supports the introduc-
tion of planned visits.
These systems have improved workflow efficiencies in several ways without
requiring new hires or taxing current staff. EHRs can include abnormality prompts
that indicate to a provider that certain tests are missing for a particular patient.
These types of prompts can improve the workflow as well as quality of care. One site
includes each of the three components of the diabetic foot exam in its EHR.” [ 17 ]
So, success under an ACO does appear to increase if health information technol-
ogy is used appropriately. From a provider perspective, however, this requires a
substantial investment beyond whatever money is paid by the incentive programs if
they are successful in meeting the requirements for extra reimbursement. In addi-
tion to the technology, new care models need to be put in place and this can require
additional space or renovations of existing space, retraining of employees as well as
hiring new kinds of employees such as care coordinators.
Reflecting on this would suggest that a health system that makes this investment
would be better off if the cost could be spread out among as many patients as pos-
sible so that the benefits of success would be greater. The opportunity to do this
seems to be growing as most of the major private insurers are following the trend
that Medicare has started with outcome-based payment systems of their own. [ 18 ]
[ 19 ] [ 20 ] [ 21 ]
Two of them have gone far beyond that. In 2010 UnitedHealth acquired Axolotl
(now called OptunInsight), the largest supplier of HIE technology, and Aetna
acquired Medicity, the second largest supplier. These two companies obviously see
health informatics as such a strategic tool for managing outcome-based care that they
want to provide the tools themselves, presumably to create competitive advantage.
Taken together these new Federal programs create incentives for providers to
deploy electronic medical records and utilize them, along with health information
exchange, to manage new care models that improve quality while reducing costs.
At least that is the hope. The results are far from clear but I'm optimistic they will
be positive, if the programs are fairly designed in a manner that allows providers to
experiment and find models that work for them locally and if they are given a
sufficient chance to work in our highly charged and polarized health political
environment. 6
6 For an excellent discussion of the ACO concept from all the major perspectives, I strongly recom-
mend you read the report by the Taconic Health Information Network and Community (THINC)
in the Hudson Valley of NY State. [ 22 ]