Healthcare Payment Reform Redefines Healthcare IT Solution Requirements

Healthcare payment reform is a work in process. The Centers for Medicare and Medicaid Services (CMS) Innovation Center is rolling out various test projects to identify how to bend the curve of healthcare costs while improving quality outcomes. These projects are gravitating towards a common underlying reimbursement theme, a fixed payment for services covering the episode of care (ambulatory, acute, and post-acute services) with a linkage to quality outcomes. Present healthcare IT solutions do not meet the anticipated needs of the market for this new form of reimbursement. There are two key requirements a healthcare provider’s IT solution needs to provide:

  • Episode of care (ambulatory, acute and post-acute services) integrated platform supporting the data acquisition, measuring and monitoring of total services delivered
  • Financial accounting system to forecast, measure and manage the distribution of a fixed payment to various providers participating in the episode of care

These requirements are the next evolutionary step to enable a delivery system to keep its hand on the pulse of driving the highest quality of care at the lowest cost. This type of information allows a healthcare provider to adjust their care process and approach based upon measured results, the introduction of new healthcare delivery practices and/or technology. This information also creates the ability for clinicians to collectively review and discuss clinically sound data more comprehensively while creating a foundation for a culture of self-assessment.

This is a challenging set of requirements to drive information at the level of patient, risk management, and reimbursement through the entire episode of care. To meet these requirements takes a new level of thinking, business models, technology, and solutions. Until the market solidifies the new form(s) of reimbursement, healthcare executives need to start thinking about information technology requirements to support newly anticipated models. This thinking will drive analysis around which solutions need replacement or require transformation to meet future system requirements.

Presently, bridging technologies are available to meet one of these requirements. Examples are, a Health Information Exchange or new generation business intelligence analytic tools that support the virtual consolidation and reporting of data across disparate systems.

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