Executive Briefing | by Monica E. Oss | April 25, 2014
The question of exactly what technology is needed for a service provider organization to move beyond FFS to risk-based types of reimbursement was the focus of yesterday’s executive briefing (see Does My EHR Have The Functionality Needed To Manage Risk-Based Contracts?). But the framework I presented focused on the “bare essentials” of technology functionality.
To get a sense of what cutting edge technology for care management looks like, I suggest reading Four Key Technologies for Physician-Led Accountable Care Organizations, a piece in The American Journal of Managed Care by authors Farzad Mostashari, M.D. and James A. Colbert, M.D. The authors focus on four key technologies for future success in population health management – risk stratification, advanced network management, event surveillance, and patient outreach and engagement. Here is a quick look at each:
Risk Stratification – To manage consumer health and financial risk competitively, provider organizations need the ability to produce and to use predictive analytics. This requires technology powerful enough “to move beyond the current paradigm of the ‘risk score’” and to one that tracks patients’ utilization, outcomes, and cost for better predictions.”
Advanced Network Management – Networks need to provide “care at the lowest cost/highest value setting … [by] also creating (and enforcing) expectations with specialists, ancillary providers, hospitals, and post-acute providers.” What does this mean? For provider organizations moving to a care management role, they need a tech platform that can measure provider organization “performance” in terms of value and facilitate referrals to “high value” providers.
Event Surveillance – Consumers rarely get all their health care services from one organization. If you’re managing all the care for a group of consumers (the core of population health management) and have some degree of financial risk for the outcomes and cost of that population, you need the ability to track consumers across multiple care settings. Without that functionality, your ability to management health (and cost) diminishes. The investment needed is technology that can track “high-valence events such as emergency department visits and hospital admissions, discharges, and transfers….”
Patient Outreach and Engagement – In population-based management (whether a medical home or an ACO), the provider organization is responsible for consumer outcomes and resource utilization – regardless of where than consumer seeks care. This requires engagement of that consumer outside of the routine “contact” of health care – and is where technologies for consumer engagement are key.
As management teams look to developing best practices in care coordination, these essential technology functions need to be on the “must consider” list for maintaining competitive advantage.
For more on how to use new mobile technologies to improve your ability to manage risk-based contracts, join me on May 1 for our web briefing – “Using New Mobile Apps To Improve Care, Track Progress & Reduce Costs” featuring two case studies by Donna Horton, Director of Client Services, Mississippi Adolescent Center, and Christine Raftovich, Manager, Data Governance, Elwyn.