MDNews - Greater Kansas

Beyond Billing Systems: Administrative Technology Advancements I By Marlon Dauner ndusTry ceos face a number of key issues in the new health care environment to remain in leadership roles for defining future delivery and financing systems. Due to cost pressures and government initiatives for health care reform, providers are faced with a changing health services market. Strategic decisions must be made involving consolidation, data and technology, and service contracting. Each of these elements of the system is rapidly changing. How they evolve will determine, to a large extent, what the future health system will look like. consolidation Consolidation is occurring throughout the health care system. Hospitals are merging, payers are merging, and physicians are employed by hospitals and health systems. Less inclusive provider networks focused on improving patient care and reducing costs are creating new relationships among physicians and, to some extent, hospitals and payers. Specialty physicians are critical to hospitals as more and more less-intensive services are moved into outpatient settings. However, primary care physicians are a key component of the consolidation process, as they provide a significant opportunity to help lower costs through patient management decisions made daily in their practices and through selective referrals to specialists and hospitals. The recent health care reform legislation provided for two new elements that support the consolidation already occurring in the market. The emphasis on accountable care organizations (ACOs) and the provision for health insurance purchasing exchanges provide impetus for restructuring delivery processes through closer alignment of providers and for more of a retail market in the purchase of insurance coverage. Use of health information technology as a tool, care coordination as a process and realigned payments as an incentive is essential to achieve transformation. The goal is to build a better health care community that is patient-centered, coordinated, accessible, low-cost and high-quality. Achieving this goal 6 | Greater Kansas md news ��� mdnews.com requires more affiliation and joint decisionmaking among providers of care than has been inherent in the existing system. Physicians must communicate with other physicians and hospitals through new technology approaches and must use data collectively to improve care and outcomes for patients. It is likely not every hospital will align with every physician and vice versa. However, patient services may flow from one network (ACO, hospital) to another to assure patients are receiving the care they need at a cost that is optimal for the patient. Physicians and hospitals within a given network must follow common protocols, performance measures, care coordination processes and communication processes to help ensure maximum performance. They, along with ancillary providers, may also need to become more aligned. data and Technology Organizations of providers will not be capable of functioning in the new environment without major system technology upgrades and better data analytics. Clinical-related technology improvements, including new diagnostic and treatment tools, have been available to the health care market for many years. Beyond automated billing systems, the administrative technology advancements used in most businesses today have remained relatively foreign to health care providers. Clinical systems must be able to aggregate network population data for management. This includes alerts for doctors and patients and quality outcomes assessment. Promotion and communication technology must permit patients to interface easily with providers through a secure website and other communications tools to increase the engagement of patients in maintaining their health. Referral processes must allow physicians to communicate securely with each other and share real-time information during an episode of care. This is essential to improving outcomes and coordinating services at the lowest possible cost. contracting For health care professionals to effectively provide services to a market, they must have a means of taking and mitigating risk of caring for patients. This can be done through contracting with public and private payers. It can also be accomplished through risk assumption by the providers with employers; insurers; or by becoming an insurance entity. Strategic contracting will permit providers to employ their tools and processes to help lower costs and become more population- and individual patient-oriented. Contracting in the current fragmented environment pits provider against provider and against payers to maximize revenue through whatever means possible, such as higher fees or increased utilization. Sharing in the savings generated through contracted goals offers the opportunity to save dollars for the buyers of health care services while assuring providers are appropriately compensated for maintaining healthy patients and efficient resource use. additional strategic Issues + consumer engagement to drive behavior through shared decision-making, fitness, prevention and communication approaches + leveraging data for risk assumption and management, care coordination, and cost-effective services planning and patient direction + alternative care delivery/payment to promote value, efficiency and quality; protocolassisted decision support + innovative strategies, models and products for direct sale through (a) purchasing exchanges; (b) retail consumer buying and selling; and (c) reduction of fraud, waste and abuse A changing demographic, sociopolitical events, and technological advances in medicine all place an urgent need on health care facilities to stay abreast of administrative technologies. For more information or to reach Marlon Dauner, please call Health Dimensions at (316) 648-3678. ���

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