Insights from The Forum 12 Business Networking Roundtable

Topic 1: Leveraging Health Technology Innovations to Improve Health Outcomes and Achieve Cost Savings

Health technology innovations are important to emerging care delivery models like accountable care organizations (ACOs) because these models need real-time health information about their patients. Technology tools can reengineer physician workflows and power risk stratification as well as quality reporting. Mobile technology makes access to information easier and expands opportunities to capture patient-reported health data. Technology also helps bridge transitions of care and enhances home-based care services to create easy, user-friendly, and personalized experiences. They offer methods of intelligent intervention and intelligent care coordination. Innovations include tools such as remote or home monitoring, gaming, high-definition cameras, and cloud-based feedback loops to patients, as well as strategies such as using data to drive value and system efficiency. Innovations need to provide actionable information, add convenience to the care delivery process, and demonstrate positive health outcomes. Data feedback services are particularly important to promote behavior change, low-cost remote monitoring, capturing patient-generated data, and building a comprehensive patient record.

Some of the benefits related to health technology innovations include clear reductions in patient health risks, enhancing patient self-care management through peer support, setting and using technology to achieve goals, more efficient use of resources, and demonstrated behavior change. However, there are also several challenges for health technology innovations such as: changing payor and provider cultures of health care payment and delivery, cost commitment, as well as integrating technology tools into medical education.

Topic 2: Strategies to Increase Patient and Provider Engagement

As new models take on a more population health approach, engagement at both the patient and provider level become important to success. The goals and benefits of engaging patients include: keeping patients out of the hospital, medication adherence, best practice, creating a culture of trust, making information convenient, and developing a supportive environment.

Barriers to patient engagement include: difficulty using new media—only face-to-face works, trust issues among employees, health literacy, culture of the medical system, lack of clinician time to educate, scalability of total population strategies, and lack of accurate patient information for outreach.

Tactics and strategies that can be used to address these barriers include: the patient-centered medical home (PCMH) model, use of an electronic medical record (EMR), use of social media to support and reinforce, use of pharmacists and other members of the care team, and target marketing in plain language.

The barriers to engaging providers include lack of information on patients and the inability to deliver population health. Table 1 was developed to outline the goals, challenges, and strategies for patient and provider engagement.

Topic 3: Integration with Providers

One of the key benefits of integrating providers with a multidisciplinary care team, new care management services, and technology tools is reducing administrative burdens through more efficient and effective patient tracking, engagement strategies, and outcomes management.

However, a major barrier to this kind of collaboration is the evidentiary gap on the financial benefits of integrating technology solutions into clinical practices. Also, transforming the culture of clinical practices from treating individual patients to treating patient populations requires significant education, incentives, and support. Simply changing the administrative operations is not enough. A third barrier is the notion of sharing patients with a team of providers and determining caregiver responsibilities.

Successful collaborations with providers have a comprehensive plan to address caregiver responsibilities; costs to implementing new strategies, programs, or technologies; and anticipated challenges. It is important to include all allied health professionals in the care delivery process to determine individual responsibilities. Providers would be encouraged by an integrated approach to care delivery if the particular strategy demonstrates patient-centered care, reductions in current workload, cost savings, and better health outcomes.

Topic 4: Outcomes Management

Assessing program or strategy impact is important but often challenging because of many contributing factors that span both the program implementation and the methodology chosen. The overall goal of any outcomes management effort would be to assess the value or impact of a strategy or program on a specific population. As the population becomes more diverse and the programs delivered begin to increase, the process of assessing true program impact becomes even more challenging. Being able to develop a program evaluation that measures areas the organization is most interested in is a strategy that can be used to overcome many challenges associated with program evaluation.

As new models of care are implemented and tested, assessing true program impact will play a key role in model assessment. In a sense, it could be less of a challenge for ACOs and PCMHs to measure program impact if they have tracking systems such as EMRs or registries in place. In addition, the information and decision support that connects provider organizations does have the potential to both measure and improve the overall health of a population over time.

Topic 5: Expanding Business Opportunities Around Wellness Programs and Incentives in Medicare, Medicaid, Health Exchanges, and New Delivery Models

Wellness and incentives are important to patients, providers, and payors in Medicare and Medicaid to drive reduced health risks, better health outcomes, and ultimately cost savings. Health care delivery in Medicaid is particularly challenging because health care services compete with basic life needs for this population. Incentives should be aligned with an individual patient's specific health goals in order to drive improved health outcomes. Incentives should be implemented gradually by beginning with patient participation and gradually moving to the patient's chosen health goals. An alternative proposed strategy may be higher cost sharing for patients who do not take advantage of basic preventive services that are fully covered under Medicare or Medicaid.

Topic 6: Fundamentals and Value of Care Coordination

Care coordination is the process of facilitating multiple pathways to optimize an outcome. It is a critical component of high-quality care and overall population health. The concept of coordinated care can be measured based on outcomes such as HEDIS, Star ratings, and the existing 33 ACO quality measures that reflect/define quality and outcomes as a whole. Both process and outcome measures are important in this process.

Because the health system is nearing the breaking point, care coordination is absolutely essential to its long-term vitality. The responsibility of care coordination varies based on the payment system arrangements. In addition, care coordination can be provided by a number of stakeholders and often is based on the payer model and resources in place.

Medicalized coordinated care provides technical support to the entire longitudinal episode (end to end) of care. Coordinated care ensures that individuals are directed to the right provider at the right time and in the setting that is most convenient for that individual. Examples of policies that support this concept include Medicare Star ratings and ACOs.

Topic 7: Dual Eligible

The need for innovative, cost-effective, high-value health care services is greatest in the dual eligible population. This patient population tends to have increased incidents of mental and physical health risks and especially high health care costs.

In general, moving dual eligibles into managed care will result in positive outcomes such as promoting better health and preventing or managing chronic disease. A data-driven approach can be beneficial to dual eligibles by powering improved patient monitoring, engagement, and health risk identification for better care management. Data tools should be used to search public records to find patient contact information. Also, geostatistics within targeted areas can be used to identify which populations within dual eligibles can be grouped for risk assessment and other population health management strategies.