The Holy Grail: Balancing Clinical Care with Financial Risk and Analytics In Establishing an Effective Health Information Exchange

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We asked what is on the mind of our new members. This article was submitted by one of our newest PAeHI member organizations, Informatics Corporation of America (ICA) and here are some thoughts for your consideration.

By John Tempesco, Chief Marketing Officer

As information technology and health information exchange (HIE) increasingly becomes the answer for improving healthcare in the U.S., it is also becoming clear that improving clinical care cannot be done in a vacuum, but must include an accompanying analysis of financial risk in order to accomplish balanced results. In spite of undeniable progress made in the past two decades, healthcare costs keep rising. A recent study by The Kaiser Family Foundation reports that overall healthcare costs in the U.S. were $2.3 trillion in 2008 versus a "mere" $714 billion in 1990. While some of the culprits identified included increased insurance premiums, new technologies, increased malpractice costs and patients using emergency departments as primary care offices, it is clear that there are dual goals that must not be mutually exclusive: improving care while reining in costs.

Health information technology and, more specifically, HIE, enable the bringing together of these two critical components. By facilitating the flow of clinical information throughout a hospital, IDN or community to bring patient data to the point-of-care at the moment-of-need, while at the same time providing a financial risk assessment to providers, HIE has the capacity to enable the critical balancing needed to get healthcare costs in line while not sacrificing care.

The infrastructure that HIE provides collects enough information to include the actuarial and financial risk analytics that give a true picture of how risk and clinical care are linked. Only when risk and clinical care are integrated can a truly patient-centered approach emerge, because only then will providers have the proper incentive and the necessary tools to deliver the best care with the appropriate risk in the most efficient way. Care-related transactions such as ePrescribing, provide clinical and financial decision support that helps guarantee that evidence-based medicine is delivered and that providers are aware of quality and efficiency goals.

For better or worse, this new environment places more risk upon the backs of providers. Providers are faced with new and greater accountability for care coordination costs as well as ensuring the best care. Technologies linking different specialists and facilities will help providers share information so that an environment of trust can be created. Clinical data exchange will enable a patient-centric approach across multiple care settings; data aggregation will enable the creation of a longitudinal patient record combining acute, ambulatory, payer and financial information; performance management will create actionable patient information at the point-of-care with dashboards that measure the effective confluence of clinical care and financial goals; and a reporting and financial infrastructure will monitor quality on a real-time basis, identify where the dollars are going and distribute payments based on value and performance.

Shaping a management system in this environment presents an enormous challenge. As the landscape shifts, uncertainty will continue to prevail. Everything will be judged by performance. Providers must be willing to bear more risk to manage evolving and changing risk populations. Increased quality can no longer be accompanied by increased cost. The goal is increased quality with lower cost.

About John Tempesco

John Tempesco, FACHE, is the Chief Marketing Officer at Informatics Corporation of America. John has 34 years of health care experience, including a career in health information technology as a civilian and for the United States Navy as a health care administrator.

About Tim Wareham

Tim Wareham, Director, Regional Sales DC, MD, NJ, NY, PA, W. VA, is the local contact for Informatics Corporation of America (ICA).

Informatics Corporation of America (ICA), 1801 West End Ave., Ste. 1000, Nashville, TN 37203 or tim.wareham@icainformatics.com

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