Randy L. Thomas

There is near-universal agreement that health care in the United States and in many areas around the world is close to "hitting the wall." Costs are escalating at unsustainable rates. Access to care is uneven. Quality suffers. Incremental change moves too slowly to address these critical issues.

 This column is based on the recently released study by the IBM Institute for Business Value, Healthcare 2015:  Win-Win or Lose-Lose?A Portrait and a Path To Transformation. Randy Thomas is one of the authors of the study.

Health care needs to transform itself to become more efficient and effective. Politicians talk about it-and even draft legislation. Policy wonks conduct studies and publish papers describing the challenges and possible remedies. Employers, payers, healthcare providers, and consumers all weigh in with different points of view. Although the problem is enormously complex and the posited solutions vary, one theme is consistent: Health care must adopt standards-based, interoperable IT solutions.

Diagnosis: A System in Crisis

To set these rather bold statements in the proper framework, let's first briefly review the various drivers that are contributing to the growing crisis-well-known factors such as increasing globalization and consumerism, the aging population, increasing rates of obesity, the increasing rate of chronic disease, and new medical technologies. These drivers escalate the need to find ways to contain costs while at the same time improve not only healthcare delivery, but also health status. The demands on healthcare delivery systems around the world are increasing at the same time that global competition is exerting pressure for overall healthcare cost reduction, and as consumers are demanding better, more advanced, and less-expensive care.

Contrasted with these drivers are a number of key inhibitors that currently stand in the way of solutions, such as the lack of aligned incentives (especially financial), the inability to align short-term needs with long-term policy, societal expectations, and the lack of access to information. While all of these inhibitors to change are daunting, perhaps the most significant one-on which all possibility of change may hinge-is the issue of unaligned financial incentives. Preventive care, midlevel provider reimbursement, and nontraditional care settings (e.g., retail health clinics, "e-visits," and telemedicine) are some of the healthcare activities that need financial support different from current payment mechanisms.

If we accept that these drivers will continue to exert pressure on healthcare providers, there are three macro changes required to overcome the inhibitors that continue to drive up healthcare costs and slow improvements in quality-and all of them require the pervasive adoption of standards-based health IT.

Focus on value. Consumers, providers, and payers must increasingly direct healthcare purchasing, delivery of healthcare services, and reimbursement monies based on value.

Develop better consumers. Consumers must make better lifestyle choices and become wiser purchasers of healthcare services.

Create better options for promoting health and providing care. Consumers must increasingly seek out more convenient, effective, and efficient means, settings, and providers.

The central theme running through these issues is the availability of reliable information.  All stakeholders in the healthcare ecosystem-governments, employers, payers, providers, medical device and pharmaceutical companies, and patients-will need superior tools that provide unprecedented access to healthcare data in a secure and appropriate manner.

Path to a Cure: Interoperable IT

The ability to make value-based decisions regarding healthcare choices requires access to consistent data on cost, quality, and access. Becoming a better healthcare consumer means not only having access to information about providers, treatments, and other healthcare areas, but also having the ability to become better educated about various lifestyle options. And finally, new care delivery mechanisms that are decentralized and nontraditional (e.g., over the Internet, in the home, at the local food market, offered by mid-level providers) can exist only if healthcare information access is secure, private, and ubiquitous.

While the adoption of standards-based electronic health record technology and the proliferation of patient centric networks are crucial elements of the HIT Rx for health care, they are not the only tools required. Equally important will be remote diagnostic tools, home monitoring options, and the ability to correlate and manipulate vast amounts of genetic, health status, and other data to identify targeted best practices-to name just a few. Essential to all of this technology will be the adoption of transaction and clinical content standards that make information portable and reliable.

Today, consumers often have little direct responsibility for bearing the costs of health care. But this situation is rapidly changing as employer-based health plans require ever-greater employee contributions and the number of uninsured continues to grow. Meanwhile, healthcare consumers have little access to meaningful comparative data on which to make "comparison shopping" healthcare decisions. As consumers directly shoulder an increasing portion of healthcare costs, they will require, even demand, information about the quality and cost of care. And this information must be readily accessible, reliable, comparable, and understandable. The only way to efficiently and economically meet this increasing demand for information about healthcare delivery is to broadly adopt standards-based, interoperable IT that both supports the delivery of healthcare and captures data in a reliable, structured way for use in reporting.

While preventive care, which focuses on keeping people well through disease prevention, early detection, and health promotion, is a concept widely hailed as a means to drive down healthcare costs and improve health status, there is little incentive to promote it. There is evidence, however, that as consumers are paying more out of pocket for health care, they will be more interested in evidence-based approaches to preventive care. This will require a level of information about the effectiveness of various traditional and nontraditional preventive strategies applied to the specific profile of a consumer, including genetic profile. Acute care delivery will also benefit from improved access to process and outcomes data on which to develop evidence-based approaches to care that are proven effective and efficient. With reliable information as a foundation, variability in care delivery (and along with it, cost) can be dramatically reduced.

The management of chronic conditions can also benefit from the application of IT. Today, as the incidence of chronic illness explodes, chronic care management remains expensive, labor intensive, and plagued by wide variations in the effectiveness of care. But IT-enabled disease management programs have the ability to improve outcomes and lower costs through the use of home monitoring devices (e.g., scales, blood pressure cuffs, glucosometers) that wirelessly communicate information to rules-based systems, alerting a patient's provider should something be amiss (e.g., an upward weight trend for a congestive heart failure patient).

Steps Toward a Clean Bill of Health

Rational healthcare choices of all kinds and positive transformation require better information. A robust IT infrastructure is needed to provide the information required to improve quality and cost, to eliminate clinical and administrative waste, to improve clinician productivity, to inform and thereby empower consumers, to make informed decisions, and to trigger insights that can lead to innovations and the ability to make informed, tough decisions.

Randy L. Thomas, FHIMSS, is an associate partner, Healthlink, a division of IBM, part of IBM Global Business Services, Marlton, N.J. (thomasra@us.ibm.com).

Publication Date: Friday, December 01, 2006

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