e-CareManagement blog

We’ve spent the past year creating the MU (meaningful use) requirements for Stage 1 of the HITECH act.  As shown by the diagram above, Stage 1 focuses on Data Capture and Sharing. Now it’s time to begin to focus on Stage 2 (Advanced Clinical Processes) and Stage 3 (Improved Outcomes).

The current generation of EMRs (electronic medical records) were designed primarily to assist care providers with clinical documentation, billing, and maximizing revenues. They were not designed to enable care coordination and optimize population health.  

This essay is the first in a new, ongoing series that will highlight:

• Design and metrics for Stages 2 and 3 of the HITECH act
• Companies and care providers developing and using applications targeting Stage 2 and 3 MU objectives

This first essay will provide an overview of what we’ve seen in Stage 1 and what we might expect in Stages 2 and 3. Continue reading “Overview: Here Come Stages 2 and 3 of HITECH!”

…Australian citizens, that is…not U.S. citizens.  See Dr. David Moore’s writeup in Australian Health Information Technology.

Of course, you’d never see this type broad support for centralized EHRs in the U.S.

Is this good or bad? You can decide for yourself…but at the very least this caught my attention as illustrating communitarian vs. individualistic tendencies in different world nations.

fyi, here’s a copy of my PowerPoint presentation at today’s Healthcare Unbound conference.

The Twitter hashtag for the event is #HCU10.

by Jaan Sidorov, MD and Vince Kuraitis

The Medicare MAPCP (Multi-Payer Advanced Primary Care Practice) demo promised to be Medicare’s Biggest Change in 40 Years…

…but the emerging reality isn’t living up to the promise.

In this post, we’ll discuss:

1. The Promise
2. An Overview of the MAPCP Demo
3. Our Main Takeaway: Emerging Reality Suggests Medicare Will Be a “Difficult” Partner
4. Conclusion: Think Twice Before Signing Up

1) The Promise

The sandbox metaphor was first used by the National Academy for State Health Policy:

For the 10 or more states that are active stakeholders in multi-payer medical home initiatives, the promise of Medicare getting in the sandbox with them and playing (a.k.a. paying) is an exciting proposition. The addition of Medicare as payer to some of these state initiatives may be the critical tipping point that results in widespread primary care delivery system reform in states by involving more practices, payers and patients. Continue reading “Medicare MAPCP Medical Home Demo: CMS Kicks Sands in the States’ Faces”

(click on the graphic to download the document)

Depending on the nature of the payment changes which are made, physicians may need to enhance their capabilities in some or all of the following sixteen areas:

1. Achieving sufficient patient volume to support a new or improved service.
2. Having sufficient upfront capital to design and implement a new or improved service.
3. Having the skills/experience to efficiently/effectively implement a new/improved service.
4. Having the ability to obtain and analyze data on the quality of services.
5. Having the skills/experience to improve the quality of services.
6. Having adequate resources to support high-quality service delivery.
7. Gaining access to external resources to support patient adherence and health improvement.
8. Obtaining and analyzing data on the variation in services per episode or per patient.

Continue reading “16 Capabilities Physicians Will Need to Implement New Payment Models”

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue.  He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

• Defending Plan A to your dying breath?
• Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.

In this essay we’ll discuss:

1) The Need for HITECH Plan B

2) Questioning Assumptions — Issues to Reconsider in Plan B

a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping Certification

3) Summing Up

Continue reading “Is HITECH Working? #7: Where’s Plan B? Congress and ONC need to address major flaws in HITECH.”

The Emerging Market in Health Care Innovation
Tilman Ehrbeck, Nicolaus Henke, and Thomas Kibasi
McKinsey Quarterly May 2010
McKinsey conducted research in partnership with the World Economic Forum to study the most promising novel forms of health care delivery and, in particular, to understand how these innovations changed its economics.

The Delineation of Home Healthcare: The Natural Evolution of a Healthy Industry
Wyatt Matas & Associates (investment bankers), April 2010
This whitepaper discusses the opportunity for home healthcare to become the center of chronic care disease management and identifies a particular business model that some more advanced companies are implementing.

EHR Software Market Share Analysis
Chris Thorman
Software Advice; May 14, 2010
A substantive analysis of a tricky market – physician EHRs.

Disease Management: Does it Work?
Jill Bernstein, Deborah Chollet, and G. Gregory Peterson
Mathematica Issue Brief; May 17, 2010
Mathematica revisits a debate that’s raged for over a decade:

• Not yet consensus that DM works
• Relatively effective disease management programs have some characteristics in common:
  • They use individualized case management.
  • They contact patients in person, not just by phone.
  • They focus on hospital discharges as key opportunities to improve health outcomes.
  • They encourage patients to use effective treatments by reducing cost-sharing for these treatments.

Continue reading “Nuggets”

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

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….or to be more specific, HITECH is synergistic with payment reform that could come from the recently passed national health care reform legislation — the Patient Protection and Affordable Care Act (PPACA).

We’ll keep this post fairly short and try to avoid many of the more divisive aspects of this topic. The need for healthcare payment reform is well understood on both sides of the aisle:

Realizing the full potential of health IT depends in no small measure on changing the health care system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of electronic health records. Dr. David Blumenthal,  New England Journal of Medicine, April 9, 2009

Continue reading “Is HITECH Working? #6: HITECH and Health Reform Objectives are Synergistic”