Viewing -- and informing -- hospital organizations as regional health networks

By Frank Ingari, CEO of NaviNet

On the heels of the Supreme Court's historic 5-4 decision last June to uphold the Affordable Care Act (ACA), payers and others within the healthcare industry must redouble efforts to comply with the law's information technology requirements. The coming year promises to be one in which health IT deployment reaches never-before-seen heights. The onus is on executives and leaders to encourage IT adoption and the collaboration it can enable.

Payer organizations, in particular, will need to start thinking in terms of the ways IT can efficiently and securely connect broader networks of hospitals, ancillary clinics and group practices. The scale of the IT changes now being mandated are so large that neither hospitals nor payers will be able to make them alone. As a result, leaders from all sides must begin to work together, as well as to recognize that IT is no longer merely a support function – it is central to strategic execution.

Collaboration through IT

Across the industry, technology and change management trends are being influenced by the ACA as well as by pilot programs such as the Centers for Medicare & Medicaid Services “Bundled Payments for Care Improvement” initiative. Programs like these are designed to encourage the industry to cooperate to provide more streamlined and coordinated care during a patient’s hospital stay and after discharge, with the goal of both lowering unnecessary costs and improving patient outcomes.

The support of such care delivery and reimbursement models will require IT infrastructures similar to those already deployed in many emerging accountable care organizations. Communicating the intrinsic value of these technologies to stakeholders throughout healthcare has now become a high-priority task for chief information officers and other leaders.

In fact, moving into 2013, one of the chief goals of CIOs and other executives will be to convince end users to view technology as a critical linchpin of day-to-day workflow. This change management initiative will coincide with the large influx of IT being introduced in medical facilities either as a mandatory or incentivized component of the ACA.

Deployment in the Clinical Environment

Electronic health records will continue to lead the pack as the most broadly adopted technology by the healthcare industry, especially given the incentives and eventual disincentives provided through Meaningful Use legislation. EHRs are expected to play a pivotal role in improving the efficiency and quality of patient care by automating and centralizing patient data, which in turn can help facilitate its seamless exchange among providers and facilities across the healthcare continuum.

To that end, warehouses that securely store voluminous amounts of patient data, sophisticated data analytic systems that offer clinical decision support, and extensive networks that can connect various points along the healthcare continuum are rapidly becoming the new order of the day. This is where payers have an opportunity to play a pivotal role.

As hospitals, clinics and group practices increasingly look for ways to align themselves either as formal ACOs or in other collaborative arrangements, forward-thinking health plans have a unique opportunity to help encourage the adoption of IT that enables shared accountability. Payers that view these growing hospital organizations as nothing less than regional health networks can help support the appropriate flow of patient information and other data among all the relevant parties.

Indeed, the use of technology innovations to achieve health information exchange and interoperability among wide-spread, disparate parts of the continuum of care – from facilities to providers to payers – is destined to become more commonplace over the next few years. Consumer-engaging applications will help extend the reach of health information to include the patient as well. The recent proliferation of mobile applications designed to digitally connect patients to their providers and health data substantiates the demand and growth potential of these applications.

Learning from Past Trends to Prepare for the Future

The healthcare industry is finally embracing the reality of the current imperative, which is to deploy robust and sustainable technology platforms that link providers, patients, ancillary health centers and payers seamlessly and securely. The threefold objective of any IT system must be to help enhance the quality of care, reduce costs and ensure regulatory compliance.

History has shown that efforts to dismantle negative mindsets about the use of IT in the clinical setting will fall short without adequate stakeholder buy-in and a thorough vetting of available technology. By keeping abreast of the latest trends in attitude as well as technology, that pitfall can be avoided.

In 2013 and the years beyond, the door is open for payers to begin shifting mindsets as well as technology strategies. By viewing large hospital networks not as isolated entities, but rather as de facto regional delivery systems, health plans can respond nimbly to innovations that simplify multi-facility, multi-provider and even multi-payer interactions. Enabled by technology, this new perception can help payers pave the way for improvements in both patient outcomes and the global healthcare bottom line.

Frank Ingari is the CEO of NaviNet, a healthcare communications network with hundreds of thousands of subscribed healthcare professionals.

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