A Seismic Shift Seen Toward Coordinated Care
A number of key Medicare and Medicaid health indicators have shifted since the Affordable Care Act was passed, and healthcare IT systems were behind many of these shifts, said Rahul Rajkumar, MD, Deputy Director of the Center for Medicare and Medicaid Innovation.
Speaking to a record-high audience from 40 states at the State Healthcare IT Connect Summit in Baltimore, Rajkumar said that
• Growth rates of Medicare and Medicaid costs slowed to practically zero (compared to GDP growth of three percent), since 2008.
• In their first year, Pioneer Accountable Care Organizations (ACOs) met all their clinical quality and patient experience measures.
• Dramatic increases in care quality were seen, from 72 to 85 percent.
• The Partnership for Patients model saw a 17% reduction in hospital acquired infections from 2010 to 2013, translating into 50,000 lives saved and $12 billion in savings.
How did this happen? Rajkumar compared two model systems, one in his grandfather’s India, in which a clinic that diagnosed and treated his relative’s stroke demanded cash payments up front. The other was in Arkansas, where a CMMI model called SAMA care delivers care in teams, each of which has a care coordinator that provides preventive care for 19,000 patients. Using Allscripts, the teams can determine missed treatments and necessary follow-up care. They also use risk stratification tools to determine necessary care before a patient even comes in for a visit.
Healthcare in the US is shifting from the first system, which Rajkumar described as “the more you do, the more we pay you,” to “one that sends a new signal to the market place, that demands care that is patient centered, sustainable, and coordinated.”
New systems being developed by CMMI are helping change the way we pay providers, the way we deliver healthcare, and our capability to deliver “the right information at the right time to make the right decisions,” Rajkumar said.
More healthcare systems are moving from pure fee-for-service, into a payment system with some links to value and quality (including hospital value-based purchasing and quality reporting, to a future that will see paying for value with expanded ACOs and patient-centered medical homes, to, ultimately a payment system that compensates providers for care to a whole population, without any triggers by specific services. “Three years ago, nobody was beyond the second system, with links to value and quality,” Rajkumar said. “But by 2016, 30 percent of Medicare payments will be in alternative payment circles. By 2018, the majority will be in alternate payment systems.”
But no healthcare official, whether in IT, finance or clinical care, should forget the primary objective of healthcare system changes. “My call to action to you is to, in your day to day work, wear the hat of a patient. If we live long enough, we all will be Medicare beneficiaries. We will all be patients.”
Rahul Rajkumar, MD, Deputy Director of the Center for Medicare and Medicaid Innovation recently presented at the 2015 State HIT Connect Summit, March 23-24 in Baltimore, MD – a national forum bringing together public and private thought leaders to share and benchmark implementation strategies of state health IT systems as they move forward with their diverse healthcare transformation and reform strategies.
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