In today's political environment, President Obama and health care are synonymous with the Affordable Care Act. But there are many more aspects to President Obama's health care agenda that are often drowned out by partisan rhetoric.
Our health care system is complex, and there is no silver bullet to solve all the problems that plague it. But one thing holds true: Technology has transformed nearly every sector of the U.S. economy... except health care.
Advancements in technology have been the catalyst to societal transformation. The telephone, originally developed to improve internal business efficiencies, quickly became a tool for market growth by connecting business with consumers. The trend continues today at an exponentially accelerated pace thanks to innovations like text messaging, social media, and the Internet.
Even before President Obama took office, there was considerable debate about leveraging technology to help curb rising health care costs, improving the quality of care patients receive and increasing efficiencies in the system. This debate led to the passage of the HITECH Act in 2009, part of the Stimulus law, which allocated billions of dollars to incentivize doctors and hospitals to adopt electronic health records (EHRs).
The Act's Meaningful Use Program has facilitated the adoption and use of EHRs by more than half of all hospitals and physicians by providing $27 billion over ten years. Health care providers must meet federal standards, which are being implemented in phases over several years, in order to qualify for incentives. Hospitals stand to gain millions from both Medicare and Medicaid. Doctors and certain other providers can get between $44,000 and $63,000 from either program, but, unlike hospitals, cannot qualify for both. To receive payments, doctors and hospitals must, among other requirements, write a certain number of prescriptions electronically, share a summary of care record when a patient is transferred to a different care provider, and engage patients through portals, secure messaging and the like. Lab results must be provided electronically, and providers must report on certain quality measures.
These standards are fine. But they haven't empowered stakeholders to access, in real time, the information necessary to excise costs through better care, quality and workflows. For patients, the standards are so low and being phased in so slowly, little change is yet evident. For payers and consumers, the lack of an information-sharing platform (interoperability) means lower costs have yet to materialize.
And a central problem is we have largely digitized and automated the current paper-based system. We have changed, but not transformed; rippled, but not disrupted.
While this specific legislation was passed to propel our health care system into the 21st century, it certainly was not designed to be the end-all solution to our nation's health care struggles. Current health care spending is unsustainable over time for various reasons: fee-for-service creates powerful incentives to over-treat; coordinating care without robust information is hard; engaging patients in their care is difficult without the right tools; local provider health markets are largely monopolies or uncompetitive, just to name a few.
These problems may seem intractable, but not impossible to address. The general consensus is that health IT will lower health care costs by improving information needed to empower providers to succeed in new payment and delivery models, such as ACOs and medical homes, which incentivize efficiencies and promote better outcomes for patients.
The administration has done a wonderful job promoting the models but has missed the boat on standards to make the models hugely successful. Robust interoperability, where any member of a care team can access and update information on a chronically ill patient and that information be immediately available to any other team member, is a hoped-for goal in 2016. So while the administration marches as fast as possible on the models of care, it slow walks interoperability.
The absence of an architecture and road map, also creates uncertainty in the market. If the market had confidence in an end goal, it would allow organizations to accelerate adoption of systems and processes that support integrated and coordinated patient care across the entire system of providers.
So what, specifically, can be done? There are many measures that both Congress and the administration can address to push our health care system towards more efficiency, lower costs and better outcomes. Namely:
- Establish a national framework for anywhere, any time health care that eliminates geographic licensure restrictions, modernizes payment models for multi-modal care, and reimburses service in Federal Health Plans;