Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Benefits, Challenges of Value-Based Health IT Implementation

Health IT implementation can help providers succeed under value-based care, but providers should ensure that appropriate products are being integrated into routine care.

- From EHR systems to mHealth apps, health IT has the potential to help providers achieve value-based care goals. But with hundreds of new technologies seemingly emerging each day, many providers are struggling to select the most appropriate health IT implementation projects to improve patient care and optimize their healthcare revenue cycle.

Providers should consider how health IT implementation can boost patient engagement and value-based reimbursement, an expert says

Providers should focus on health IT implementation projects that promote better disease prevention and management through increased patient engagement, which will in turn maximize value-based reimbursement, Eric Peterson, MD, MPH, FAHA, FACC, a lead volunteer at the American Heart Association’s new Center for Health Technology and Innovation, told RevCycleIntelligence.com.

“With the shift from procedural and time-based reimbursements to more population, risk, and disease management reimbursements, providers are paid for better disease treatment and, for the cases that we can, better prevention of those diseases,” said Peterson, who is also the Executive Director of the Duke Clinical Research Institute.

“When one gets in that world, the potential for technology be it mobile, EHR-driven, or other has remarkable capacity to allow for better disease prevention or, if disease occurs, better disease management,” he added. “It shifts the emphasis away from physicians providing services to patients to engaging patients in their own health and disease management.”

Under value-based care, patient engagement becomes increasingly important to the healthcare revenue cycle. When provider compensation depends on preventing adverse healthcare events, then getting the patient to be an active participant in their healthcare is key to maximizing value-based reimbursement.

For example, Peterson noted that many patients fail to follow long-term medication plans for half of their prescriptions. In fee-for-service arrangements, medication adherence barely affects healthcare revenue cycle, but it could hurt a hospital’s bottom line under value-based reimbursement models.

“In current fee-for-service systems, it doesn’t really matter,” Peterson pointed out. “You get paid for seeing the patients and providing services. You might actually lower your bottom line if you do a really good job at disease management and prevention.”

“In the future when we shift to world where you’re being paid either the bundled payment, in which you’re on the hook for a period of time, or to manage a certain set of populations, then preventing subsequent events or preventing disease becomes remarkably valuable.”

Health IT has the potential to improve disease management and prevent adverse events by engaging patients with their health in their own homes, Peterson added.

“On the potential side, I think there is incredible opportunities here,” he said. “Some devices allow you to detect in patient homes whether they have occurrences or if they’re at risk for deterioration, etc. Those are everything from heart rate and blood pressure monitors to devices that measure pressures in the various chambers of the heart and electrical instability. You name it, there are technologies out there that can potentially monitor patients pretty in depth in their own home environment.”

These technologies create a healthcare data feedback loop that can influence patient behavior and allow providers to manage patients outside of their office.

“The information can be fed back to the patient to change their behaviors,” said Peterson. “For example, if your blood pressure is high today that may be an indication that you didn’t take your medicine or something as simple as that. Or your fluid seems to be up, so you might want to take a bigger diuretic.”

“That information can also go back to the provider so we can see how well you’re doing in terms of your electrical stability or your blood pressure control rates or any number of different things. Therefore, it allows you to be better managed.”

The technologies also help hospitals to optimize their workflows, Peterson mentioned. Hospitals can focus on outpatient or inpatient visits, which is when patients are usually the sickest, and shift well-being services outside of the hospital setting.

“Assuming you don’t have huge excess capacity for visiting patients in the outpatient clinic or seeing people in your hospital setting, then you make money by having focused in on the higher reimbursement or where you need added people and technology,” said Peterson.

Other health IT innovations that could improve healthcare revenue cycle under value-based care include those that replace existing provider services, Peterson continued. For example, nurses or physical therapists go to patient homes or patients go to a facility for rehabilitation services, but some healthcare technologies now allow providers to monitor a patient’s rehabilitation outside of the healthcare site.

Providers can also prevent unnecessary office visits or hospital admissions through electronic personal coaches or artificial intelligence devices that answer simple questions. The technologies “help triage some of the things that would have typically had to be done by human or, in worse case scenarios, would have mandated a patient coming into the office to be evaluated,” Peterson said.

“In those settings, we’ve now supplanted or replaced expensive event, human visits to homes or patient visits to a clinic, with a technology and personalized feedback system directly between the technology and the human,” he continued.

Despite the potential benefits of health IT implementation, Peterson mentioned that providers must carefully weed through seemingly endless pitches to select the most appropriate and effective products. Unlike other healthcare products, such as prescription drugs and medical devices, health IT innovations do not go through the same testing and implementation process.

“There’s a ton of new technologies out there,” Peterson said. “However, there’s very little evidence whether any of these products work. If you were to reverse it and look at a new drug or device used in medicine, most of them have already gone through extensive study and evaluation. Most of them have been through the FDA and most of them have been vetted by large payers, such as Medicare, to decide who or what will be covered.”

“If you flip that and now say, ‘Well, we have this new wonderful device that helps you manage your heart failure population in their own home and it’ll do all these things.’ Do we really have great evidence that it will do all those great things? That’s the challenge presented to hospitals right now.”

Health IT implementation may also be stymied by the disconnect between the healthcare and technological worlds, Peterson added. Hospital leaders and technology developers need to bridge the gap to understand how to create and implement technology in the healthcare setting.

“What we were finding out is that there was a big gulf between hospital administrators or healthcare providers in general who have limited knowledge about what is happening with all the changes in technology and its potential to affect how they deliver care,” he said.

Similarly, some technology developers do not understand how products can be applied to healthcare and integrated effectively into existing care delivery models and technological infrastructure. As a result, Peterson noted that there are “hundreds of thousands of apps out there and almost none are routinely recommended by the healthcare field.”

For successful health IT implementation, Peterson stated that three parties – hospital leaders, technology developers, and clinicians – need to be on the same page. First, hospital leaders need to commit to value-based care adoption, including new methods for improving quality and patient engagement as well as lowering healthcare costs.

“The priority is to get things that will reduce readmissions, improve patient outcomes, and so on,” asserted Peterson. “That’s obviously an important big step and we want to be on the cutting edge. Those are the things the leadership of the hospital will drive.”

Next, technology developers “must find ways to adopt these technologies into the health world and address concerns about patient safety, privacy, corruption of their systems, integration of other technology outside and inside the hospital,” he added.

But, most importantly, Peterson stated that clinicians must be comfortable with using and applying health IT, especially as part of their routine care. If clinicians are not reporting any efficiency or quality improvements, then health IT implementation will not be successful.

“The more we can make that clear to clinicians, that this technology is helping them better manage their patients, then we’ll win,” Peterson said.

Dig Deeper:

What Is Value-Based Care, What It Means for Providers?

How mHealth Technology Supports Patient Engagement Strategies

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