One only needs to look at the statistics in hospitals throughout the US to see that healthcare is changing. Inpatient and ER visits are down across the board, even to the point of double-digit percentages over last year for some facilities. Ambulatory surgery and outpatient visits, however, are up if you are lucky enough to be the entity of choice for your service population.
In order to meet the needs of the new population management healthcare models, successful hospitals are adding more and more primary care and practice-oriented specialty providers. While in some ways these models seem similar to previous capitation and HMO models of the 1970s, population management is about driving down cost but with a new twist that focuses not only on financial saving/efficiency, but also on driving quality outcomes and reducing readmissions.
Whether it is the economy, Obamacare, the cost of insurance, or other drivers, the population management model — which includes ACOs, home health, Medicare Shared Savings programs, and other examples — is driving the need for CIOs to shift their skills and knowledge from being experts on inpatient information and billing systems to a host of other solutions involving practice management systems, data mining, utilization management, and increased complex integration between disparate systems. Often this means being able to access and analyze data around population utilization, claims, risk, care gaps, cost effective treatment methodology from a host of different sources — most of which are external to your organization — and figure out a way to manage and mine it to provide value-add information to stakeholders.
For many CIOs, this is new ground and results in a continuous learning experience — not just for them and their team, but for the whole organization. Many organizations are exploring not just a single model but several at the same time, looking to see which program or model best fits their organization, customers, and service area. CMS has openly stated they fully expect most organizations to shift from one model to another based on their successes or failure during exploratory development. While larger organizations and academic medical centers are perhaps used to dealing with data mining, the data needs of these new models will surely stretch the intellectual capital and IT resources of smaller organizations and especially rural entities.
On the Health Affairs Blog, Erin Bartolini wrote, “A shift towards patient-centered care is driving industry to develop solutions that help ACOs achieve these new population-health goals. They are doing this by developing tailored solutions that incorporate prevention strategies, behavioral changes, genomic factors, and home-based or community-based interventions that get to the underlying factors of a patient’s health.” All of that will require accompanying IT solutions that enable remote data capture, in-home patient monitoring, or data exchange between independent or captive provider practices. In many cases, the solutions will be constantly evolving based on what information the tools can provide, and whether they are driven from the top-down or from the bottom up based on clinician needs or recommendations. Regardless, it is another argument that CIOs need to be agile and able to develop solutions, even when they don’t know what they don’t know.
It will also require CIOs to interact more than ever before with clinicians and providers to help understand their needs and desires, and provide information on every aspect of patient-centric care. Many facilities are exploring new care models that will use committee approaches and review boards to assess data and proven evidence-based decisions and ultimately decide which drugs or devices should be used. The team approach to evaluating new products and clinical guidelines based on safety, effectiveness, patient-centeredness, regulatory compliance and cost will require CIOs to help define what data can be gathered and what collaborative solutions — which often involve competitors or non-healthcare partners — the CIO can bring to the table. The CIO will also need to know more about logistics to help identify data points and solutions that address workflow needs and provide recommendations around identifying low-cost, effective supply chain components.
In short, in order to be successful, CIOs must be more agile, have broader business relationships along with greater business process understanding, be able to lead non-IT business areas, and be able to deliver on innovative solutions. Under these new care models, the traditional delivery of IT services and solutions has evolved into a minimum expectation of basic skills that is no longer seen as having true value. CIOs who can evolve and say that they are truly innovative and are able to understand and add value from a true business perspective are those who will see success in the future.