Some encouraging innovations show how health care can be improved, especially with technology, if policymakers begin to address difficult questions, a panel of experts said recently.
Matthew Press, M.D., and Wendy Everett, Sc.D., discuss how technology and payment innovation are changing the delivery of care during a recent Alliance for Health Reform event.
During a panel discussion(www.allhealth.org) hosted by the Alliance for Health Reform, several speakers addressed ways to support the latest innovations in patient care and the barriers that need to be overcome in order to expand the use of new ideas and technologies.
Wendy Everett, Sc.D., CEO of the Network for Excellence in Health Innovation, said one of the group's ongoing projects helped decrease mortality rates by 30 percent and save costs by using remote monitoring in facilities with fewer resources, including intensive care settings that have a limited number of physicians.
Cameras in the rooms allowed a support team of physicians to monitor patient progress and assist an attending physician. Physicians meeting with the patients initially were concerned about independence but eventually embraced the idea, Everett said. She cited an Institute of Medicine report(www.nationalacademies.org) that said it takes an average of 17 years for innovation to be adopted into the health care delivery system.
- The volume of investment being poured into health care technology continues to grow rapidly.
- Panelists at the Alliance for Health Reform said payment innovation has been successful, yet technology has lagged behind.
- Electronic records are capturing crucial data such as smoking habits, medical non-compliance and homelessness, but the data is not being extracted from a patient's record.
"We can love it in the abstraction, but when it comes down to adopting them and changing the way you practice it is really hard," Everett said.
In India and China smartphones equipped with otoscopes are helpful in checking for ear infections in rural areas that have limited access to health care facilities. The data is transmitted to a lab in an urban area for analysis.
"There's no reason that technology cannot be introduced here," Everett said.
Everett mentioned the Global Lab for Innovation(uclainnovates.org) as a tool to help spread innovations that reduce cost and improve access to care. Some innovation could be simple, she said, such as distributing research findings through social media rather than waiting a year to 18 months to have it published.
Medical innovation gets support through legislation in some states, notably Massachusetts, Maryland, Oregon and Vermont, Everett said, but is hindered elsewhere.
"The Texas legislature passed a law where they will only pay for a face-to-face visit with a physician," Everett said. "That's going back to the 19th century."
The volume of investment being poured into health care technology continues to grow rapidly. There was more financial investment in health care IT during the final quarter of 2014 than there was during all of 2013.
"Innovation is not found in payment models; it is much more common in technology," said Daniel Riskin, M.D., CEO of Vanguard Medical Technologies.
But he cautioned that innovation should not be an end in itself.
Riskin said information about serious diseases such as diabetes is not always recorded accurately. Policymakers need to address difficult questions regarding interoperability between reporting systems and require that patient records be accurate, he said.
Innovation in payment has been successful, Riskin said, and he believes medical professionals do not want to return to fee-for-service, yet technology has lagged behind. As a comparison, he mentioned that when the federal highway system was developed in the 1950s government officials insisted that roads be the same size and connect with one another. Trying to achieve that sort of consistency in a national health information highway has been tougher.
"That hope has not been realized," he said. "The payment models have shown early successes but the infrastructure such as electronic health record usability, quality measurement and interoperability are problematic. We have data being stored in silos."
Electronic health records (EHRs) are capturing crucial data such as smoking habits, medical non-compliance and homelessness, Riskin said, but the data is not being extracted from a patient's record in a way that allows for analysis of the barriers to receiving care as part of population health efforts.
"We're overly focused on EHRs and not enough on analytics," Riskin said.
Alternative Payment Models Show Success
Several alternative payment models introduced as part of the Patient Protection and Affordable Care Act (ACA) are showing "remarkable success," according to Matthew Press, M.D., senior advisor to CMS. He said 26 new payment models have been introduced since 2011.
He said savings are also being realized in the Comprehensive Primary Care Initiative, which recorded a 2 percent reduction, valued at $14 per patient, for Medicare Part A and Part B. The initiative includes nearly 500 practices and an estimated 2.5 million patients.
At the close of the event the speakers were asked what will be the next disruptive innovation in health care. Everett believes the use of sensors will increase within about three years. They can be effective tools for diagnosing disease, monitoring adverse events before they cause harm and enabling patients to care for themselves, she said.
Riskin believes more information will be retrieved from electronic health records that will enable physicians and others to identify patients who are at the greatest risk for hospitalization. More information will be shared between the single record and data collectors after ICD-10 regulations are fully implemented during the next two years, Riskin said.