Recent industry developments highlight how health care innovation can benefit providers and payers in the long-term. Here's our take on what you need to know to maintain and create business value.
Alternative Care Delivery Models
Medicare hopes to attract as many as 5,000 physician practices to new primary-care initiative
The Centers for Medicare & Medicaid Services unveiled its latest valued-based reimbursement model called the Comprehensive Primary Care Plus initiative. The agency hopes to attract as many as 5,000 physician practices in 20 areas of the country to the program. Participating practices will have a choice of two tracks with the same care delivery requirements, but with different financial risk components. The tracks emphasize chronic disease management, preventative care, care coordination and patient engagement, including 24-hour patient access to health information. CMS will begin accepting practice applications for the five-year initiative in July.
78% of family practitioners say telemedicine can improve access to primary-care services
That's according to the results of a 2014 survey of 1,557 family practitioners conducted by the American Academy of Family Physicians. Another 68 percent said the use of telemedicine can improve the continuity of care for patients. Despite those benefits, only 15 percent said they used telemedicine in the previous 12 months to consult with or treat their patients. The top two barriers were lack of training and lack of reimbursement, cited by 54 percent and 53 percent, respectively, of the respondents.
Health Information Technology
71.5% of physicians in PCMHs or ACOs who use EHRs routinely measured quality of care
That's compared with just 22 percent of physicians without EHRs and who don't participate in a PCMH or ACO. The figures come from a new study in the American Journal of Managed Care. The study, based on a 2012 survey of about 2,600 physicians, showed that doctors who have EHRs and participate in value-based care models are more likely to use health IT to improve care. The study looked at the impact of EHR adoption and PCMH/ACO participation on four areas critical to value-based care models: quality measurement, population management, patient communication and care coordination. In each case, doctors who used EHRs and participated in PCMHs or ACOs were far more likely to routinely perform those functions than doctors with no EHRs and not in PCMHs or ACOs or doctors with EHRs and no PCMH/ACO participation.
74.1% of physician practices are using a certified EHR system
That's according to the latest physician EHR adoption data released by the National Center for Health Statistics. The NCHS defined certified EHR systems as those meeting CMS' “meaningful use” criteria for 2014. Physician practices with certified EHRs were more likely to share patient health information electronically with other ambulatory providers or hospitals. According to the NCHS, 47.8 percent of physician practices with certified EHRs shared patient data with others compared with 29.7 percent of practices with non-certified EHRs. Less common was sharing patient health information electronically with behavioral health, long-term care and home-care providers regardless of EHR certification. Even with certified EHRs, the percentage of physician practices sharing patient data with those providers was 14 percent, 13.6 percent and 15.2 percent, respectively.
Only 21% of surveyed consumers describe themselves as being “very engaged” in their health care
That disconcerting finding comes from a patient engagement report released by Frost & Sullivan, the San Antonio, Texas-based market research firm. The report is based on a survey of 1,500 consumers. On the other side of the ledger are the 74 percent who described themselves as “somewhat engaged,” “not very engaged,” or “not at all engaged” in their health care. The results suggest an uphill climb for health plans and providers that are relying on increased patient engagement to make their value-based care models work.
66% of the nation's 100 largest hospitals offer mobile health applications to their patients
That's according to a research report from Accenture. However, the report said only 2 percent of the patients treated by those hospitals are using the apps. That's largely because the mobile apps being offered fail to provide patients with the three digital capabilities they expect most: access to medical records; schedule, cancel and change appointments; and fill prescriptions. Accenture said, “Large hospitals that design and build experiences as well as partner with digital disruptors will have the ability to better engage with their patients.”
Revenue Cycle Management
94% of health plan price estimator tools let enrollees comparison shop for provider based on price
That's according to a new study in the American Journal of Managed Care. The study is based on a survey of 43 health plans and a review of the price estimator tools they provide to their enrollees. Some 31 plans, or 72 percent, had such tools. Of those that did offer such tools to enrollees, 29, or 94 percent, of the mobile or online tools let enrollees shop for providers based on price. Eighteen, or 58 percent, let members get price estimates for prescription medications. Only 14, or 48 percent, though, included provider clinical performance data performance. Absent that performance data, enrollees may equate higher prices with better care and choose more expensive providers without knowing they could get better value elsewhere, the study said.
Hospitals' uncompensated-care tab is $42.8 billion, equal to 5.3% of total expenses
Uncompensated-care is the sum of a hospital's charity care (care given without expectation of payment) and bad debt (care given for which payment was expected but not collected). In 2014, hospitals' total uncompensated-care costs dropped for the first time in 14 years to $42.8 billion after climbing steadily to $46.4 billion in 2013, according to figures released by the American Hospital Association (PDF, 183 KB). The tab in 2014 represents 5.3 percent of hospitals' total expenses that year, which is an all-time low. The drop likely is the result of more hospitalized patients having health benefits thanks to the coverage mandates under the Patient Protection and Affordable Care Act.