Citing the goal of improving treatment, health, and costs, health care providers in the nation are dedicating resources to enhancing knowledge in health IT and redesigning care. The achievement of all three of these objectives is a precondition to sustaining any one of them for the entire American healthcare system.
Over the years, economists and health IT professionals have forecast a wide range of cost savings from health IT implementation. These evaluations are difficult because they need specialists to forecast how health IT will affect provider and consumer behaviour changes and how those behaviour changes will affect quality and cost results.
Yet it is still important to understand how health IT can support the nation’s efforts to “bend the cost curve” and ultimately slow the growth of health care spending, while improving outcomes and the health of the population. Within this context, a single health care health IT-enabled intervention that achieves the goal of improving health care quality may be more likely to spread if that intervention has also demonstrated measurable net reductions in healthcare services expenditures.
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Roundtable to Promote Value in Canada’s Health Care System
This would create a venue for convening a diverse group of national level experts from the field of health economics, IT specialists and policy makers with a subject matter focus on health IT from the perspectives of cost and value as forces that can shape the future of health care. While the Canadian roundtable could learn from examples such as from the U.S., it could look at which kind of health IT-enabled interventions actually lead to reductions in health care costs, better differentiated outcomes for the patients, or better care coordination. Again due to the single-payer system in Canada and demographic diversity of the population, the roundtable would be interested in developing solutions that would be scalable across provinces given the best interest of patients, providers as well as paying institutions.
However, this roundtable could also focus on the fact that modern government agencies, provincial health authorities, and private sector should work together for the development of standardized tools to assess the value of health IT experiments. Regional experiences from other successful areas such as the Beacon Communities of the United States could have informed the next steps of adopting new HIIT solutions for chronic disease management, remote patient monitoring, and telehealth. Reading these models could help Canada’s health care system emulate and modify strategies behind health IT to kindle a value-based health care environment that improves health care accessibility while still addressing the escalating cost of health care.
One of the Problems
The organizations that implement innovative interventions that result in quality improvements and cost reductions are often not the sole beneficiaries of these interventions’ cost savings. Providers often touch patients covered by multiple insurers (such as Medicare, Medicaid, private insurers, and employer-owned health plans), each with its own strategic and financial imperatives. Encounter-based claims data and other information needed to measure holistic cost impact can be inaccessible, leading implementing organizations to take a “wait and see” approach. For example, they may hope that clinical improvements such as reduced readmissions will convince payers or other stakeholders to work with them to sustain the intervention, even though the impact on costs may not be fully demonstrated.
How the Beacon Communities Fit In
The Beacon Community Program funded 17 communities with average three-year awards of $15 million each to demonstrate replicable health IT-enabled interventions that achieve the three-part aim. In many ways, these communities are no different from delivery systems and their partnering organizations that are working on health IT-enabled transformations across the country. However, by participating in the Beacon Program, they have agreed to openly share their processes of change, including their processes for engaging payers in conversations about financial impact and sustainability. Part of our job at ONC is to ensure we learn as much as possible from these innovative communities, and share their lessons effectively with the rest of the country.
What We Accomplished
The Engelberg Center’s roundtable discussion was not intended to serve as a formal evaluation meeting that would render a final evaluation of the Beacon Communities’ current efforts. Rather, the output of this meeting made it easier for Beacon Communities and others engaged in similar work around the country to prospectively study the impact of promising IT-supported care improvement initiatives on overall health care spending.
“This meeting was overdue,” said Aaron McKethan, former director of the Beacon Community Program. “While some of the Beacon Communities are advanced in their payer relationships and in measuring cost savings, there are many implementers out there who are not yet able to show the payer community that claims about the cost effects of their interventions are credible. This creates noise, and it is hard to differentiate between what will have a real sustainable impact, and what will only increase health care spending in the long run.”
George Schneider, chief financial officer at Geisinger Health System, Keystone Beacon Community, added:
“As a health plan as well as a delivery system, Geisinger is a strong believer in the idea that high quality care is efficient care. Providers are partners with insurers in developing innovations in the care delivery process supported by innovations in reimbursement approaches that include payments for quality. We were very pleased to have an opportunity to share our experience in cost measurement with the Roundtable and to learn how other Beacons are addressing critical measurement and partnership issues around paying for quality in their own communities.”
What Are These Beacons doing?
The Colorado Beacon Community is giving physician practices a tutorial on how to shed the most light on the meaningful use of health IT in a variety of scenarios; The Tulsa Beacon Community has shown that being beacons of innovation means using health IT in new ways to help doctors of various specialties who are involved in a patient’s care to communicate with each other more efficiently about how they can best support the patient and his caregiver in receiving the best care possible. Keystone Beacon Community employ use of health IT for persons with frailty and multiplicity of chronic conditions aiming at minimizing hospitalizations and other forms of unnecessary health care consumption and enhancing quality of patients life.
These efforts are representative of Beacon Communities more broadly and are similar to initiatives cropping up across the country.
Conclusion
By raising the standard of treatment, cutting costs, and fostering improved health outcomes, health IT has the power to completely change the health care system. The Beacon Community Program illustrates how IT-enabled interventions can spur innovation in the management of chronic diseases, care coordination, and payer relationships, drawing on findings from roundtable conversations. Measuring financial effects and making sure cost savings benefit all stakeholders remain difficult, though. Communities may develop scalable, long-lasting solutions that not only enhance treatment but also help to bend the national health care cost curve by exchanging lessons learned.
