Every year the HIMSS Annual Conference generates a tremendous amount of opportunity, promise, hype and more. While many pronouncements are usually made at the conference, the question always arises what will stick following the conference. From that perspective, a few recurring themes from conversations at the conference stuck out in my mind.
The focus of my trips to HIMSS in 2016 and 2017 was privacy and security, but that changed this year. While I still had a number of privacy and security focused discussions, I also wanted to learn more about what is happening on the value based care front. With that in mind, I met with a number of individuals in the space or others who are considering how to develop tools to assist value based care.
One conversation was with Tom Bizzaro from First Databank. With Tom, the discussion focused more on the health policy side of the equation. Namely, what is or can be done by Congress and/or regulators within the Centers for Medicare and Medicaid Services. That conversation led down the path of determining that not much hope necessarily can be placed in those institutions. Since the beginning of 2017, the pace of pushing into value based care through Medicare has been slowing down. The BPCI Advanced model may be a glimmer of hope, but any benefit remains to be seen until participants are actually in the program, which will not be for a fair amount of time. In what would become a recurring theme across a number of conversations, the issue of a unique patient identifier came up. The argument runs that without a unique identifier, many questions arise as to the accuracy and reliability of data about an individual. Even in closed systems, such as Kaiser in California, misalignment, and others issues arise with data. If that happens in a closed system, how can the larger healthcare ecosystem be trusted to attach the right data to the right person?
From a policy perspective, the issue is not really a desire for the government to have to develop the patient identifier so much as remove the barriers to doing so. A unique patient identifier has long been contemplated under federal law, but policy blocks any attempt to actually begin or otherwise pursue development. Following that point, Tom then brought up the not too long ago CHIME lead challenge on the unique patient identifier front. Many may remember the seemingly abrupt notification that the challenge was canceled without much detail provided as to why. The announcement becomes even more puzzling in light of Tom’s information that a winner was expected to be announced within 6 or8 weeks from the time the challenge was ended. Why? That is the open question on that front. Looping back to the value based care front, as already suggested, the patient identifier can help validate information, which is needed to establish a full continuum of care.
The unique patient identifier concept also factored into my discussion of value based care with Lidia Fonseca from Quest Quanum. Lidia also identified the need to have reliable data that follows a patient. Quest is in a somewhat different position in this regard from other entities because it interacts with so many patients, providers, and payors. It may be one of a handful of companies with such a diverse array of touchpoints that are always being accessed. Diving more into the value based care realm, Lidia hammered the need to focus on all of the sides that form healthcare (the patient, provider, and payor trifecta) and enable each side to access the information that it wants and/or needs. Examples of such information include transparency around cost for patients, ease of accessing and ordering services for providers by making tools fit seamlessly into workflows, and having claims and service information available and flowing between providers and payors. Combining those elements goes to shifting the focus of the healthcare industry from reacting to events to proactively trying to keep individuals healthy and ostensibly outside the walls of a traditional healthcare provider.
Discussion of shifting the underlying premise of the healthcare industry turned to also rethinking the design and purpose of the new technological tools being used. Lidia suggested that the electronic medical record, a common focal point for complaints, was not designed to support a value based care approach. The functional design of many EMRs was to support the creation of a medico-legal record and/or support billing. While some may disagree with the assertions, there is a fair amount of accuracy in the description. The accuracy is supported by the desire of some major EMR vendors to no longer be called “EMR vendors,” but instead to be thought of as a centralized workflow tool that brings all data points and separate pieces of the healthcare system together. If that end can be achieved, then maybe the technological tools will be in place to meaningfully support and drive value based care.
Coming around to design, Lidia’s description of her preferred role as a change agent struck me. Lidia described her role in many organizations as being the person to shake up operations and redesign old systems. She referenced design thinking, which takes empathy as a first step in creating tools. It is hard to argue with the suggestion to bring empathy into the process of recreating the EMR or even coming up with completely new tools. Regardless of the approach, the basic message was one of needing to embrace change and push to make it happen.
A third conversation that focused on value based care was with Mason Beard from Philips Wellcentive. Mason described a long-standing role in the realm of trying to drive value and meaning from data as well as shifting the manner in which care is delivered. Mason referenced the genesis of those efforts coming from Michigan in the early 2000s as well as the alternative quality contracts of Blue Cross in Massachusetts. Those designs arguably with some of the more recent forerunners of current value based care paradigms. The discussion with Mason focused on the need for creating new frameworks around relationships and not accepting the status quo. Examples of driving this change could include establishing new terms for arrangements between payors and providers and even potentially shifting solely to more direct relationships between employers and providers.
One more conversation bearing on value based care was with Carina Edwards from Imprivata. The conversation actually indirectly turned to value based care, but did loop the themes back around to the need for a patient identifier and seamless workflow between systems. Carina referenced the ability to pre-identify individuals before entering the healthcare system and then to validate their identity once the patient presents. If identity can be verified right from the start, such a scenario naturally fits into a value based care world because it enhances the continuum.
The rundown above focuses only on pre-scheduled meetings. The number of informal and/or impromptu discussions about value based care are too numerous to fully capture. However, the ideas that were the subject of those discussions aligned with the concepts discussed with Tom, Lidia, Mason, and Carina. The system must continue to change and that recognition is there.
The final thought from HIMSS at this point is to offer another means of thanks to Regina Holliday. After much delay on my part, I finally became a member of The Walking Gallery and received my jacket from Regina. The message of my jacket is that as a healthcare lawyer, I want to breakdown barriers that may be constructed by participants in the healthcare industry through a misunderstanding or misapplication of laws and regulations impacting healthcare. Innovation is possible and even encouraged by those laws and regulations. While the path may not be the one considered at first, there is a path and I want to educate others on the means of finding that path and/or serving as a guide.
Coming back to my initial statement, the mood during HIMSS is one of optimism and energy. It is hard to sustain those feelings throughout and across years. However, all must remember that the goal is to create a better system that results in better quality and respects everyone attached to the healthcare system.