A recent report stated that U.S. healthcare spending increased 3.6 percent to reach $2.9 trillion in 2013, the fifth consecutive year of growth. This unsustainable growth, the continued reimbursement squeeze on healthcare providers and relentless regulatory challenges all suggest that a deliberate shift in focus to one of value and cost-containment is unavoidable. It is with this shift in mind that we believe the following predictions will unfold in 2015:
- Market consolidation continues. With federal and private insurers seeking to reduce costs by shifting from fee-for-service to shared savings, bundled payments and other risk-sharing reimbursement models, providers and payers will increasingly look to accountable care organization (ACO) formation. These models will address value-based purchasing (VBP) challenges, coordinate care and better manage the impact of rising costs. Early mergers are driving standardization or introducing data aggregation tools or both that foster better understanding of the “big picture,” and improved management of key performance indicators (KPI) that create the outcomes necessary to meet contractual and financial needs.
- Government and regulatory challenges are here to stay. While many are proclaiming the death ofMeaningful Use (MU) and predicting another ICD-10 delay, the reality is that these programs are law. MU penalties start January 1, 2015. Stage 2 raised the bar for compliance significantly, reportedly resulting in very low industry MU2 attestation. The 2014 ICD-10 delay meant that many of these projects stalled or were intentionally put on the back burner. Organizations will need to quickly assess their current state and develop programs that lean heavy on process and testing to get over the October 2015 finish line.
- There’s money in DSRIPs. Delivery System Reform Incentive Payment Programs (DSRIP) have goals aligned with the Triple Aim of improving outcomes for underserved populations. Large federal dollars are available for state-wide DSRIP programs. States like California and Texas have gone through round one with California seeing modest success; New York is just beginning. 2015 will continue to see these programs develop nationally with patient centered medical home programs serving as primary drivers.
- Data analytics becomes a cornerstone to population health. The December 2014 HIMSS electronic medical record (EMR) Adoption Model reports 64 percent of U.S. hospitals have implemented computerized physician order entry (CPOE) and an EMR. Collectively, we now have more patient data than ever. Future value-based purchasing programs and accountable care organizations will require even more data. The year 2015 will continue to see widespread adoption of electronic systems and the capture of new data elements across the healthcare continuum. With this onslaught of data comes even greater IT challenges sparking increased need for strong governance, refined architectures, and new tools to address volume and validity issues.
- Focus on (actionable) data. The year 2015 will bring the dawn of real techniques for identifying data patterns and trends that expose new value. Research and emerging products turn unstructured notes into actionable knowledge through natural language processing will further mature. Organizations already struggling with internal data warehouse development will now face new data and unstructured information from external entities. To succeed, organizations will institute strong data governance programs with dedicated staff to manage information quality, and flexible architectures that can accommodate large and complex data volumes while supporting ever-changing business requirements.
- HIEs get smarter. Surviving health information exchanges (HIEs) realize the power of the data they broker between organizations and build value-add features to fund sustainment. In 2015, HIEs will continue to evolve into entities that provide rich data analytics reporting, patient engagement portals,secure messaging, and referral alignment. A continued drive towards interoperability and tighter partnerships between HIEs and ACOs is anticipated, especially for those ACOs lacking strong IT programs. Vendors and organizations will maintain their focus on adoption of the Integrating the Healthcare Enterprise (IHE) framework and “open records” via an orchestrated interoperability architecture based on open APIs. Broad adoption of CCDA for transition of care documents will continue; however, we should anticipate evolution to the easier-to-implement-and-parse HL7 Fast Health Interoperable Resources (FHIR) markup language.
- The (mHealth) future looks bright. Increased healthcare consumerism, a more sophisticated “buyer” and elevated consumer technology consumption are changing access to care from bricks and mortar to convenient retail models, telemedicine and mHealth.
2015: Value and cost containment will be in the spotlight
- Revenue cycle software undergoes resurgence. Alongside today’s electronic health records (EHRs), hospitals find older financial systems aren’t built to bill under emerging accountable reimbursement/ payment structures or to break out payments to individual ACO members. These legacy solutions also do not generate the data necessary to negotiate payer contracts. All these factors mean providers will increasingly look to update or replace older financial systems with technology better equipped to meet demands.
- EMRs (finally) move past implementation. In recent years, organizations have implemented these massive systems with aggressive timelines. Many slammed in systems and built workarounds to achieve MU initially. As a result, these organizations now face the need to undergo large optimization and MU rescue efforts. The year 2015 will see organizations implementing additional scope, addressing concerns around build and workflow, and evaluating ways to improve overall performance and achieve MU attestation.
Linda Lockwood, R.N., MBA, PCMH CCE, is solution director, Advisory Services, CTG Health Solutions
Mike Garzone is solution director, Technology Services, CTG Health Solutions.