Why the Solution to Population Health Management Woes Isn’t an EMR

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To succeed in the future, hospitals must demonstrate quantitatively that they operate more effectively, more efficiently and more safely. This requires hospitals to identify and reduce waste in three categories:

  1. Waste due to variation in the care that is ordered
  2. Waste due to variation in how efficiently that care is delivered
  3. Waste due to variation in care delivery that causes preventable complications.

Population Health Management SolutionsAccording to several estimates, including a 2012 report from the Institute of Medicine, approximately 30 percent of U.S. healthcare spending in 2009 was wasteful, including unnecessary services, medical errors, poor care coordination, excessive administrative costs, fraud and other problems. But previously, waste elimination wasn’t a priority because under fee-for-service (volume-based purchasing), waste generated additional revenue.

Now that public and private payers are reducing payments or refusing to pay for poor-quality care, including care that is defective or unsafe, waste is becoming a financial drain on hospital bottom lines. For example, last October the Centers for Medicare and Medicaid Services (CMS) withheld a percentage of Medicare payments to almost 1,500 hospitals because of high rates of patients readmitted within 30 days of being treated. At that time, CMS also expanded the list of preventable hospital-acquired conditions it won’t pay for from nine to 11. Those hospital-acquired conditions include, for example, pressure ulcers; injuries caused by falls; central-line and urinary catheter-associated infections, and surgical infections resulting from arterial bypass grafts, bariatric surgery for obesity and certain orthopedic procedures.

Clearly, these new CMS reimbursement policies and other industry quality measures linked to payment are pressuring hospital bottom lines more than ever. To stay profitable and remain competitive, organizations today must make clinical and operational excellence an ongoing priority.

That’s where we find ourselves today as healthcare systems are struggling to figure out how the shift to a value-based model impacts their operations and bottom line. Simultaneously, they must also address complementary but competing priorities, including:

  • emerging shared-risk payment models such as Accountable Care Organizations (ACOs), patient-centered medical homes (PCMHs) and bundled payments;
  • the deployment or upgrade of an electronic medical record (EMR) to capture documentation data electronically and qualify for Meaningful Use incentives;
  • new reimbursement “carrots and sticks” tied to quality and efficiency outcomes;
  • transitioning to a patient-centered care model;
  • a shortage of qualified health information technology (HIT) professionals; and
  • overall industry consolidation.

Not surprisingly, this has strained internal resources and left many health systems scrambling to remain a half step ahead of regulatory timetables. Unfortunately, this management-by-crisis style isn’t always driving organizations to take the right steps. Instead, we see a proliferation of tactical “point solutions,” which address immediate needs but at the expense of an integrated, strategic plan that addresses long-term needs as well.

In short, we need better solutions. These won’t come solely in the form of an EMR, which is only one component needed to provide the actionable intelligence that health systems need to survive. They also won’t come from analytics packages offered by EMR vendors or from existing business intelligence/analytics tools, which fall short of being able to support the dramatic transformation currently underway.

What’s needed is the industry-wide adoption of adaptive, clinical data warehouses capable of integrating disparate transactional source systems and analytical tools that can provide crucial actionable intelligence – intelligence usable by health system clinicians to identify opportunities to improve clinical effectiveness, cost effectiveness, and safety. Once healthcare systems begin to use the full power of their data, they’ll be able to make care decisions based on the insights they discover. And with proper information management support, these healthcare organizations will provide care that is more effective, more efficient, and safer, all at a lower cost.

Learn more about Dr. Burton’s solutions for the transformation in healthcare from his webinar, Population Health Fundamentals.

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The link to the recorded on demand webinar is: /webinar/population-health-fundamentals/

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