IOM Calls for Greater Efficiency, Technology and Engagement
September 16, 2012 - Citing the healthcare system’s inefficiencies and costs of care, a new report from the Institute of Medicine calls for the creation of a continuously learning health system, which improves by capturing and disseminating lessons learned, embracing new technologies, engaging patients and families, establishing greater teamwork, and increasing transparency within organizations.
Brett Furst called the IOM report “spot on” for identifying what’s needed to move healthcare forward.
“For the most part, it is spot on,” said Brett Furst, CEO of ArborMetrix in Ann Arbor, Mich. “No one can argue transparency of information, decision support tools and engagement of patients are bad ideas.”
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America ties in the focus on performance and value-based purchasing coming out of the Affordable Care Act, he added. Providers are more attentive to quality of care and how it relates to reimbursement. The IOM outlines how to move forward and recommends incentives that align to encourage continuous improvement, reduce waste and reward high-value care.
“It’s a great document, and one that will be talked about for weeks to come and maybe referred to for years to come,” Furst said.
The committee that wrote the report estimates 30 percent of health care spending, about $750 billion in 2009, was wasted on unnecessary services, excessive administrative costs, fraud and other problems.
John Byrne, MBA, FACHE, emphasized the role human connections plays in patient engagement and improving adherence to treatment plans.
“It’s pretty ambitious how much money they think we can save, but that doesn’t mean we shouldn’t be trying, of course we should,” said John Byrne, MBA, FACHE, chief operating officer at Downstate Long Island College Hospital in Brooklyn, N.Y.
Best Care at Lower Cost builds on prior IOM reports, including To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st century, and offers a road map toward its goal. The Blue Shield of California Foundation, Charina Endowment Fund and Robert Wood Johnson Foundation funded the report.
“Much of what they are talking about doing is the same [as Crossing the Quality Chasm], which tells us we haven’t gotten very far in 10 years,” said Matthew Holt, co-chair of Health 2.0 in San Francisco, and a participant in one of the committee’s working groups. However, with more digital data available, “we should be able to get to a learning healthcare system more quickly.”
Jason Beans, CEO of Rising Medical Solutions in Chicago, added, while the “report is dead on, it’s a lot harder to do than it makes it sound.”
Drawing on data
Hospitals and providers have invested in technology to collect data, with good results.
“Technology has had a profound influence on outcomes and patient safety,” said Ralph Lawson, chairman of the Healthcare Financial Management Association and chief financial officer for Baptist Health South Florida in Miami. And he expects that will grow, because currently much of the information remains with providers.
“As we unlock those silos and share that information, the impact on cost will be profound, because a major cost driver is mismanagement of chronic diseases,” Lawson said. “Information is needed to manage chronic diseases more effectively.”
The IOM encourages clinicians to analyze real-time data to hone in on areas ripe for improvement, take corrective actions and save money while enhancing quality.
“There’s a call to capture data and use it and best practices,” said Mary Beth Navarra-Sirio, RN, MBA, vice president and safety officer at McKesson in Pittsburgh, Penn. “Healthcare technology aids us to ensure the best evidence is used when we are taking care of patients at the point of care.”
That may include clinical decision support, alerts, reminders, systems that notify providers of gaps in care and dashboards to track patients. For example, physicians with such systems now can quickly identify diabetics with high A1c levels and send an email asking them to come in and consult with a diabetes educator.
Mary Beth Navarra-Sirio, RN, MBA, said technology can help in identifying real-time gaps in care and correcting the course while delivering care.
“More powerful are things like identifying real-time gaps in care and correcting the course while delivering care,” Navarra-Sirio said.
But to provide meaningful information, input data must be accurate. ArborMetrix, for example, pulls its data from various sources, integrates it and presents it in a benchmarking format usable to clinicians and hospital leaders. Beans indicated privacy protections have made it more difficult to mine and share data.
“For this to work, experts need to analyze their areas of expertise,” Beans said. “I think it will change things in healthcare dramatically once people know what outcomes are and the cost.”
Technology also can help providers connect with patients, Holt said. For example, companies such as Teladoc and American Well are offering online physician visits, which reduce healthcare costs.
Teladoc, a Dallas-based telehealth provider, offers an alternative to expensive emergency department care for nonemergent conditions, such as sinus or urinary tract infections. Rent-A-Center contracts with Teladoc for 12,300 employees for 24/7 access, 365 days a year, to online consults, which has saved the company more than $770,000 in 16 months, with employees reporting a 97 percent satisfaction rate.
Jason Gorevic finds telehealth services can reduce the cost of healthcare by offering people with nonemergent conditions a less-expensive alternative to the ED.
“We’re a clinical services company using technology to improve access and as a byproduct driving down cost to the healthcare system,” said Jason Gorevic, CEO of Teladoc.
Teladoc tells patients the costs upfront, adding to the transparency of healthcare.
Increased transparency about the costs and outcomes of care can boost opportunities for healthcare to learn and improve and should be a hallmark of institutions’ organizational cultures, the IOM committee said.
Technology functions in the background and can deliver those results to websites where people can access it.
Currently, “decisions are made without outcomes and costs taken into account,” Beans said. “By engaging the patient, showing the price up front and having discussions, you can change things.”
The IOM report encourages clinicians and care organizations to not only fully adapt technologies but to urge patients to use tools, such as personal health records.
“The hope with patient engagement is that we can get some of the quality of life information into the equation, because it will help us make better decisions,” said Furst, adding that mobile devices will help in engaging patients, because patients want convenience.
For instance, patients taking their vital signs or blood sugar levels daily and sending them to the cloud, where providers can spot trends and intervene, are just getting off the ground, Holt said. But clinicians have not been paid for that kind of monitoring. That will change with bundled payments and accountable care organizations (ACOs), managing populations more efficiently for a set amount of money.
Younger people will expect health data to be there, on smartphones and iPads, and if providers are not offering it, for instance making them fill out family-history forms a second time, they will seek care elsewhere, Furst expects.
“There will be an overwhelming relaxation of privacy and an expectation of connectedness,” Furst said.
Byrne, on the other hand, emphasized the role human connections plays in patient engagement and improving adherence to treatment plans.
“Part of it is building an environment of trust and caring, that’s how you build compliance,” Byrne said. “This report talks about empowering the patient and making the patient a key member of the healthcare team. If you do it, you will improve your outcomes, and if you give patient-centered care, you should be able to target what you are doing to save money.”
Lawson also credits family involvement with improving patient engagement at Baptist Health South Florida.
Changing the culture
The IOM report also calls for a culture of learning, teamwork, collaboration and adaptability, with team training and skill building.
Lawson called culture huge but cautioned that it takes time to change it.
“Culture changes never come about easily,” Byrne added. “We identified early on, in order to improve care, we had to create a culture change and create teamwork, where everyone is listened to and depends on each other.”
Byrne said an organization must build a case that changes will improve care and it will be much more difficult to undertake such change simply to save money.
Healthcare improvement takes three things, Navarra-Sirio said. Those three things are: (1) people who can lead change and are committed to a culture that supports improvement; (2) re-engineering processes; and (3) technology.
“Technology alone will not solve the problem; culture change and process change alone won’t solve the problem,” Navarra-Sirio said. “You need all three together to improve the healthcare system.”