Connected Community

HIE supports new payment models

New payment models, such as ACOs, utilize team-based care requiring providers to work together, coordinate care, and improve patient health across care facilities and specialties. Without a methodology for making sure that data and patients travel side-by-side along the care continuum, many of the industry’s other attempts to improve workflow processes, communication and coordination may be for naught.

Creating a Connected Community to Support New Payment Models

New payment models, such as ACOs, utilize team-based care requiring providers to work together, coordinate care, and improve patient health across care facilities and specialties. At the core of these new models is the secure exchange of health information across disparate digital platforms, because each member of the care team must be able to quickly access complete, current, real-time patient information.

This health IT interoperability is a key driver for success in these new models, which pose greater risk for participants but also greater rewards. Without interoperability and care coordination, there might be little payoff to participating in an ACO. If ACO members aren’t able to share information with one another to reduce duplicative procedures and other excess costs, then they likely won’t see the financial rewards of these demanding new programs.

Health information exchange (HIE) as a verb
The industry needs to evolve from simply exchanging information to establishing routine quick and easy processes to securely share relevant patient information to support better workflows. To further their care coordination process work Montrose Memorial Hospital (MMH) recently organized a community-wide seminar titled Let’s Get Connected. “There were several motivators for us to get connected, one is meeting meaningful use, and we are launching an ACO,” said Pam Foyster, MU coordinator for Montrose Memorial Hospital. “I understood we had a learning curve to exchanging continuity of care documents (CCDs) and using Direct appropriately that added to our need to connect with our community of providers. Many in our community are very motivated and trying to learn more about health information exchange as a verb, not just a noun, and how we do this together. I think as a hospital we have the responsibly to initiate the patient hand-off.”

“Health information is still siloed, so we have to adopt information exchange, as the verb, as the standard of operations and care, just like you would do vitals every four hours or do shift report, if I don’t give full information to the next health care provider taking care of this patient they are likely to miss something and patient care suffers. I view the HIE, QHN, whoever you use in your area, as the ultimate resource bucket, because pretty much anything you want to know about your patient is in there.”

Data and patients need to travel side-by-side
In order to perform and meet the demands of new payment models, providers need to leverage care settings across their medical neighborhood to ensure that patients receive appropriate care in the most cost-effective and efficient setting. Without a methodology for making sure that data and patients travel side-by-side along the care continuum, many of the industry’s other attempts to improve workflow processes, communication and coordination may be for naught.

“MMH recognizes that it is important for the full continuum of healthcare services to be in sync when patients are ready to be discharged from an acute care setting,” noted Steve Hannah, CEO at MMH. “This means that post-acute services, including LTC, sub-acute and home-based services, must be included in the transitions of care process to assure timely patient flow, to reduce the likelihood of readmissions, and to improve patient outcomes. This requires effective collaboration among service partners and structured communications to assure that vital information is conveyed wherever necessary. The hospital exists as a part of a system of care, and we are committed to collaborating with our community service partners to provide the best possible care to our patients.”

There are clear safety and quality-of-care benefits to patients and financial benefits that result from information exchange. In community-based integrated care models information sharing can help prevent unnecessary and costly repeat tests and procedures, provide the information needed to create evidence-based care plans, and make positive outcomes more likely by reducing complications caused by impaired access to information.

New payment models require a commitment to greater communication
“We are a community-based integrated health system that is well-positioned to be successful in the new reimbursement environment. By developing mutual-benefit alliances with other quality providers, we are working to ensure the future of healthcare for our region,” continued Hannah. “Our participation with our neighboring healthcare providers represents a commitment to greater communication between providers in the care continuum, especially for our patients with chronic illnesses. By improving how we work together with other hospitals and care providers across the continuum of care we expect to improve care, reduce the likelihood of duplicated and unnecessary services, enhance patient engagement, and increase the efficient use of our resources.”

“Patients move all around the map, we have to stop thinking about them as only in our practice, they access care all over the place and you don’t know what you don’t know until you login to QHN,” Foyster said. “Internally our next steps are to make sure we are providing the most accurate information possible for the receiver, so we are handing off the patient with accurate information that their caregivers can act on and nothing falls through the cracks on discharge. Overtime we need to build the verb of health information exchange, so it becomes a habit. The payment models are shifting and you have multiple hospitalizations, X number of ED visits, and you didn’t follow-up to make sure the patient is taking their meds and had a post discharge appointment, it’s going to start costing physicians, so it's important that we all start these communication habits now.”

The transition to new payment models is difficult, and Pam acknowledges “its hard work” but the ACO promise that by banding together, physician organizations, hospitals, and other care delivery organizations to share risk, reduce costs, and deliver better patient-centered care holds great potential. Balancing the stress of meeting new policy and regulatory requirements against the reality of real world, on-the-ground implementation is critical to success.

“Through our work and leadership role in Western Healthcare Alliance and Community Care Alliance, we have recently formed collaborations with neighboring hospitals in Delta, Gunnison and Aspen, and our physician clinics, in order to improve healthcare with a patient-centered approach,” said Hannah. “This approach has demonstrated to be very effective in rural communities which have unique challenges based on how and where we live.”

Pam Foyster has generously agreed to provide other medical neighborhoods, which may have an interest in initiating a similar Let Get Connected project, with guidance on how to kick start a program. She may be contacted at: pfoyster@montrosehospital.com.
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