Accountability of Care is the Center of Healthy Reform
Online First
Accountability of Care is the Center of Healthy Reform
Healthcare reform is taking center stage as the industry opens its eyes to a myriad of factors that are re-defining the healthcare landscape. There is an increased focus on patient-centric services and satisfaction that translate beyond the delivery of quality care to also enable the provision of affordable and timely care to achieve better health outcomes. The entire industry is undergoing a transformation triggered by the need to establish accountable care practices to help overcome specific issues that impede the industry’s improvement. What is the need for such accountability that fosters increased responsibility? How will this improve the current healthcare landscape? The heads of healthcare organizations are mulling over these questions in their pursuit to make the right decisions that will enable them to deliver better care to patients while also sustaining market advantage.
The way in which the healthcare industry addresses care management is shifting dramatically. Perhaps the biggest shift is holding the patient and their primary care accountable for the entire health experience. More responsibility is being shifted to providers and patients, with payers attempting to influence provider and patient behavior for better outcomes. This concept is not new and has been attempted in the past with minimal success. Now, providers and patients alike, have access to new information, knowledge, technologies, and tools that have the ability to improve care management. As a result, patients are becoming better-informed decision-makers and are playing a more involved and active role in their care. This recent shift in care management is directly related to improved accountability, which ultimately means patients will receive optimal care. The question is, how are these different groups (payers, providers, patients) responding to this shift in how care is managed? How are payers responding to the individual members, and how are they supporting care responsibility with providers and patients? How are providers and patients reacting to this new responsibility? This article will address some of these issues and discuss how changes in care management are transforming the healthcare industry and hopefully improve the accountability of the cost and quality of care.
Let us a take a look at how accountability of care management is transforming the healthcare scenario to deliver better health outcomes:
Coordinated care. Given the extent of rapid technological advancements taking place in the healthcare industry and the increased specialization, there are multiple independent practices, service centers, research and development centers, etc. devoted to specific focus areas for improved health outcomes. For instance a patient can participate in independent programs for diet, exercise, clinical trials, and social media without any information sharing other than what the patient volunteers. However, the segmentation of the healthcare delivery framework based on specialization has led to the existence of multiple independent systems that focus on parts of the problem without addressing the issue as a whole. Multiple stakeholders and non-integrated systems affect decision-making and increase the scope of error during data transfer—be it patient records, claim documents, or bill payments. Providers and payers are looking increasingly at how they can improve holistic data sharing, communication, and coordination in support of accountable care. Standardized processes and guidelines set up by accountable care organizations are also helping to improve decision-making by facilitating effective data sharing and teamwork among healthcare professionals working within the healthcare system.
Quality care. Over the years, the lack of standardized processes and systems, multiple independently functioning units, and rapidly changing medical technology and best practices has hindered the healthcare industry from achieving its full potential. Accountability of care management focuses on improving the quality of care at all the points of delivery. As accountable care organizations adopt specific quality measurement parameters to evaluate the effectiveness of care, they are further engaging patients to adhere to these quality standards such as medication adherence and scheduled monitoring of chronic conditions, and patients have taken a non-negotiable stance in terms of the quality of care being delivered. Patients are assuming the role of individual contributors and are demanding customized, quality care from providers, thereby emphasizing the need for providers to deliver enhanced care. Therefore, the accountability of care management is resulting in a significant improvement in the quality of care being delivered. Now, the focus is more on quality health outcomes than volumes of services performed.
Affordable Costs. Lifestyle changes, patient negligence in following prescribed regimens, increased incidence of chronic illnesses, high cost of prescription drugs, physicians fees etc., have resulted in increased healthcare expenditure. How does accountable care management tackle this? Technology such as EMR/EHRs, HIE, and remote monitoring contribute to the healthcare delivery system to function as a single, unified body, thereby eliminating wasteful spending. Integration of systems and coordinated care will also help in spreading awareness and boosting preventive mechanisms that will drastically reduce the need for expensive procedures and hospital admissions. Accountable care persuades providers to re-examine their current payment options that mainly focus on a ‘pay-per-service’ model and shift to a model that will involve payers compensating providers who provide affordable, quality care to patients. Accountable care management therefore acts as a medium to promote comprehensive payment reform and restructure of the healthcare system to contain costs and achieve more value for every dollar spent on healthcare.
Accountability of care management revolves around the use of information to deliver coordinated care in a system that is complex and fragmented. Payers, providers and patients are embracing their newly assigned responsibilities and are working collaboratively to deliver better outcomes.
‘Accountability’ brings the trusted ingredients of transparency, integration, economical spending and patient power to the table to establish a more responsible, coordinated system that will both reduce healthcare expenditure and improve quality of care, thereby helping organizations stay viable and competitive.
Carl Ascenzo is vice president of global healthcare solutions at Virtusa. He has more than 20 years of experience as a senior leader in information technology. At Virtusa, Ascenzo’s primary responsibility is to ensure overall client satisfaction. Additional responsibilities include developing the innovative capabilities needed to serve the Healthcare market’s current and future needs. Prior to Virtusa, he was the founder and principal consultant of Ascention Consulting. Ascention helped early and growth stage healthcare technology companies with their go-to-market strategies and plans. Before Ascention Consulting, Ascenzo was senior vice president and chief information officer at Blue Cross Blue Shield of Massachusetts. He was responsible for all aspects of information of technology supporting 3 million members, 3,500 employees, and annual revenues of $12.5B. Prior to joining Blue Cross, he was a partner with PricewaterhouseCoopers L.L.P. Ascenzo may be contacted at cascenzo@virtusa.com.