Wednesday, 20 October 2010 14:59
In a recent article on The Health Care Blog entitled 'Human Resources and Surviving Healthcare Reform', Mike Turpin spells out the big issues facing employers as they prepare to navigate the unpredictable consequences of healthcare reform legislation (PPACA).
After a dispiriting view of the challenges faced by HR professionals: "getting hit from all angles – finding it difficult to continue to transfer rising costs to employees, unwilling to absorb double-digit trends, under-staffed to intervene in the health of their populations and uninspired to assume the role of market catalyst to eliminate the perverse incentives that reward treatment of chronic illness rather than its prevention.”
He nonetheless cautions that: “inaction and lack of planning will cost employers dearly…employers must forge ahead to address the intended and unintended impacts on the estimated 180 million Americans covered under their employer-sponsored healthcare plans".
Turpin’s recommendations for action -- which include warning employers against dumping health coverage, advocating for employer self-insurance, and promoting aggressive population risk management -- culminate in the following call to arms:
"You are the 'market forces' everyone keeps talking about and you need to use this power to influence on-going reform. ... Congress will only listen to employers because the other stakeholders have a perceived conflict of interest in how health reform is ultimately resolved. Employers must build up the courage and resolve to begin to reshape the ... delivery models that result in overtreatment and lack of accountability for poor outcomes."
Employers are a sleeping giant … and it’s time to wake up!
There is enormous opportunity for employers to positively affect the health of employees, the value they get for health benefits spending, and, ultimately, the future of healthcare in the US.
On the other hand, the consequence of inaction is predictable and catastrophic.
Employers can reduce demand and streamline supply of healthcare.
What Turpin refers to as population risk management, the first way that employers can improve the value they achieve from their health benefits spending is to lower the demand for care by improving the risk profile of their employee population. For those graphically inclined, this means shifting the risk curve by encouraging those at relatively low risk to stay healthy (and get healthier) while engaging those at highest risk to change their lives.
To be successful, employers must first ascertain where health risks lie, then effectively engage employees with plan design, incentives, environmental and cultural changes. No two workforces are the same, but there is a growing and diverse array of strategies and solutions available to engage employees at all levels of risk.
The second strategy to increase return on health benefits spending is to improve the efficiency of supply by demanding more value from the healthcare delivery system. Employers that intervene and innovate around care delivery and reimbursement stand to reduce ineffective care while promoting better coordinated, higher quality care for employees.
|Lower Demand + More Efficient Supply|
||----------------------------------------------->||Healthier Employees + Lower Spending|
||----------------------------------------------->||Increased Productivity and Profitability|
So why then have employers generally been unsuccessful in achieving high value from their health benefits spending? Here are some commonly perceived barriers:
- Attitude -- I am not in the healthcare business, it’s not my mandate or expertise.
- Information -- I have no idea how to measure what value I am getting for my money.
- Empowerment -- My employees are disengaged and unaware of healthcare’s true cost.
- Impact -- I am just one purchaser of healthcare, powerless to make a structural difference.
- Agency – Even though I’m self insured I feel as though I have little control over rising costs.
- Resources -- I want to change things, but don’t have the resources to drive innovation.
None of these barriers are insurmountable if employers adopt a proactive approach and take advantage of the leverage they have:
- Attitude - A paradigm shift in thinking is required. Healthcare is a substantial cost of business that for many employers is rising at an unsustainable rate. It is therefore your business.
- Information - Get informed about what you are spending, what you are spending it on, why you are spending it, and the value you are getting for your money.
- Empowerment - Engage your employees as proactive partners in their health and care by giving them control over their health information, re-aligning their financial incentives toward health and value conscious consumerism, and providing them with an environment and corporate culture that fosters healthy lifestyle.
- Impact – The potential for employers’ collective influence over the US healthcare system cannot not be overstated. Take action cooperatively to increase your leverage.
- Agency – Many employers have ceded too much control to outside entities whose financial interests are not aligned with their own. Take control back from brokers and plans; they are not your business partners.
- Resources – Ultimately, you cannot afford not to invest in managing population risk and driving healthcare innovation. It is clear by now that nobody is riding to your rescue.
Lowering demand and streamlining supply are prizes not easily won for employers.
But with the health of their workforce, the competitiveness of their company, and the future of US healthcare hanging in the balance – they are certainly worth fighting for. The path will look different for every employer, but following these general principles puts success within reach for employers, their employees, and the future of healthcare in the US.
Friday, 01 October 2010 22:06
Looking to the impact of previous (and most current) generation PHRs to predict their future importance to health wellness and health care, given the dramatic shifts now occurring in the industry and in society, is like analyzing best-practice travel agency electronic airfare ticket handling in the mid 1990s to predict the success and impact of self-service electronic airfare ticketing in the late 1990s and beyond. It doesn’t account for the significant underlying paradigm shift that is occurring.
Next generation person-centric life-long health record platforms and the associated applications and processes that leverage them are not your Mother’s PHR of old – they are key to the transformed future “health wellness and care system” – here’s why.
Given the pervasive brokenness of the health care so-called “system”, the challenges facing health information exchange initiatives, and most importantly the powerfully entrenched industry health data hoarders, the only way you as a patient can be assured that you and your care team has the best possible relevant information is if you drive or oversee the process yourself, as only you will know if it is complete or not. The fundamental question each consumer/patient needs to consider today is: do you want to take the chance on you or your families’ health, wallet and maybe even life that somehow, given the serious systemic hurdles outlined above, your data is going to magically come together in a comprehensive and complete way at the point of critical care decision-making any time soon?
Like many other important decisions in American society, if you want it done right you have to take control and do it yourself. The government’s policy makers through the HITECH Act and Meaningful Use Stage One requirements definition have vastly improved a consumer/patient’s ability (along with a designated partner/agent such as Dossia) to take on this important responsibility.
Just as importantly, at the same time at least seven related key converging trends are leading us to a major paradigm shift in the industry:
- Growing recognition by physicians of the value of patient-sourced information (e.g., preferences, drug side-affect feedback, environmental factors) within the care decision-making process,
- Increasing consumer/patient financial skin in the game,
- Increasing patient-physician communications and joint outcome accountability,
- Movement to care models (e.g. medical home, accountable care organizations) and associated payment reform approaches that cannot reach their outcome and financial potential without leveraging a holistic 360 degree view of a patient’s data,
- Changing consumer/patient perspectives on health information privacy, sharing and associated control,
- Impending rapid growth of automatic gathering and remote monitoring of consumer/patient-sourced biometric and other data (both chronic disease and wellness related), and
- The exploding interest in mobile applications by both consumer/patients and caregivers that can only reach their true interactive potential by leveraging an integrated, comprehensive, person-centric health data view.
The combination of these unprecedented policy changes and trends creates both a powerful catalyst and disruptive environment for person-centric health records and their associated applications to be a key component within our future transformed health wellness and care system.
Thursday, 02 September 2010 18:14
Come this fall, the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA) plan to add a "Blue Button" to their electronic patient portals that will allow individuals to download their personal health information into a patient health record or other electronic media of their choosing.
This even got the attention of President Obama who announced to America's veterans that "For the first time ever, veterans will be able to go to the VA Web site, click a simple blue button, and download or print your personal health records so you have them when you need them, and can share them with your doctors outside of the VA."
Since this announcement, CMS and VA have announced the format of the data that will be downloaded and there has been much discussion surrounding the structure of these data and the challenges inherent to maintaining the integrity of data when accepted in various formats. Dossia has been asked a number of times about our readiness to take-on the data that lie on the other side of the blue button, so we figured we’d take the opportunity to address the issue on our blog.
Dossia has always been dedicated to the open exchange of personal health information. This is not just a question of the standards for data exchange, but also what the internal database of Dossia can store; the data schemas. There is no value in accepting data if there is no way to logically store it and make it available to Dossia participants.
To accomplish this goal, we have consolidated the most popular industry standards into a comprehensive and flexible set of data schemas. Our data elements primarily focus on the most common data types available across the healthcare landscape but, not only are our schemas consistent with the current industry standards, they also have been validated against actual data from health plans, providers, PBMs, human resource systems, and retail sources; including data from CMS and the VA.
Dossia's ability to integrate with a large variety of healthcare industry standards and data types is essential to its success. Thus the core of Dossia's data schema is built in accord with the systems that provide a majority of healthcare services. Over two years ago, Dossia's engineers used the VA's monographs from VistA as one of the initial sources for validating the data elements included in the Dossia base schema. In addition to mapping the core elements of VistA to the Dossia Schema, Dossia also demonstrated that appropriate components of CMS's Health Care Information System (HCIS) data files and the Shared System Integrated Repository (SSIDR) data set map directly to populate an individual's Dossia Personal Health Record. Specific analysis was derived from Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency, and Hospice), and Medicare Part B (Outpatient) For this reason, it is no surprise that Dossia would be compatible with the final ‘Blue Button’ data elements.
We welcome your suggestions and comments, as we believe that the best way to gain and grow our schema and vocabularies is through the input of others. Please post on the XML Schema discussion group at the Dossia Development Community.
Thursday, 15 April 2010 00:00
The results of a national survey focusing on consumer perceptions and engagement with health IT were recently released. The survey, which focused mainly on PHRs, was sponsored by The California HealthCare Foundation. Click here to access the report, and see below for a summary of findings.
Here at Dossia we have been asked what we think about the low percentage of respondents interested in accessing an employer sponsored PHR (25% of non-users). Our response: this is the very reason that Dossia was founded as a standalone, non-profit entity that categorically does not share health information with employers but rather maintains a completely private and secure record that is under employees' personal control.
We view respondents' interest in PHRs sponsored by providers and health plans as a function of these entities being the obvious sources of trusted health data. As consumers realize that they can access health information from multiple sources including providers, plans, pharmacies, labs, etc. they will increasingly look for a convenient way to aggregate this information. And this is where Dossia offers a distinct advantage, as Dossia aggregates data from multiple sources.
Patient portals to doctor's EMRs are indeed useful for looking at lab results, scheduling appointments, and messaging doctors but they do not give users control over their health information, and they do not aggregate health information. As the quantity and quality of electronic health information increases, and more connected health devices become available, we expect that consumers will look for a single access to point that gives them greater control over all their health information from professional, personal, and automated sources.
All in all, we at Dossia are excited to see growing interest from consumers for flexible health solutions provided in a personally controlled and private environment and we are committed to delivering these solutions to our Founders and beyond.
Summary of findings:
- 7% of respondents were using a PHR that's about twice the adoption rate calculated a couple years ago by the Markle Foundation. Use of PHRs is higher in the West (11%), and higher still in California (15%) where Kaiser's MyChart has achieved broad use.
- About half of users' PHRs were sponsored by their health plan, and about one quarter by their health care provider.
- 64% of users found it is useful to make sure their health information is accurate, 57% enjoy being able to look at test results, and about half of users find it useful to email providers and renew prescriptions online. Over half of PHR users think that using a PHR makes them feel like they know more about their health, and about the care that their doctor gives them.
- Though most PHR users tend to be younger, highly educated and of higher income, those with less education and lower income and those with chronic illnesses derive more value from using a PHR including becoming more educated, inquisitive, and proactive about improving their health.
- Overall, 40% of non-users indicate that they are interested in using a PHR if sponsored by a provider (58%), health plan (50%), company like Google or Microsoft (25%), or employer (25%).
- Non-users indicate that privacy (76%) and lack of an immediate need (61%) are the biggest barriers to adoption though less than half of PHR users are worried about privacy and two thirds of all respondents agreed that privacy concerns should NOT stop us from learning how (PHR) technology can improve health care.
- A minority of respondents (42%) have heard of PHRs, compared to 72% who have heard of EMRs.
- About half (48%) of respondents are interested in home monitoring devices, and a similar proportion (55%) are interested in health applications such as those that allow you to track illnesses, diet, exercise, etc.
Personal Health System Heavyweights Dossia, Google, and Microsoft Come Together to Advocate for Putting the Patient First in Meaningful Use
Thursday, 18 March 2010 00:00
This last Monday (March 15th) marked the close of the open comment period for the HHS proposed rule implementing ARRA provisions that provide incentive payments to healthcare providers that participate in CMS programs and adopt and meaningfully use certified electronic health record (EHR) technology.
Many comments focused on requests to relax the rules governing reimbursement so that providers could get 'partial credit' for achieving some but not all of the meaningful use criteria. Others sought clarification of requirements to make it easier for providers to comply.
Another major theme, about which Dossia has been most vocal, focused on patient access to and control over their personal health information. In addition to Dossia's own comments, Dossia's CEO, Colin Evans, participated in the Markle Foundation's collaborative commenting process.
In addition, Dossia collaborated with Google and Microsoft to advocate that patients be allowed to direct eligible providers to transmit their personal health information to their PHR:
We join together to emphasize a fundamental point: 'meaningful use' of health information technology must include enabling individuals to direct participating [physicians] and eligible hospitals to electronically transmit information to their PHR.
The intention of Congress in ARRA was very clear that everyone is entitled to a copy of their Personal Health Information sent to a destination of their choice and the Meaningful Use criteria need to reflect that commitment.
Dossia is encouraged with the ONC's openness to outside recommendations as it moves toward finalizing the criteria for CMS reimbursement, and we remain hopeful that the ONC will continue to promote policies that put the patient first.
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