By: Doug Coombs
Generally, I try to start a blog with an entertaining story, metaphor, or both. In this case it came together a bit differently, so please don’t let the first 150 words or so stop you from getting to the interesting metaphor below.
Over the past few months, I couldn’t help but notice the number of news articles announcing the formation or extension of organizations in the United States designed to align patient, provider and payer interests. A couple of those recent articles include:
Fee for Value and Pay for Performance are two names given to this concept which, in the United States, are often operationalized through organizations known as Accountable Care Organizations (ACO). If you would like to become more familiar with these concepts, visit the ACO page on the CMS.gov website where you can develop a cursory understanding quickly.
Now For Our Feature Presentation
The origin and evolution of things is fascinating. Some off-topic trivia…, which was invented first, AstroTurf, the computer hard disk, or the hula hoop? The answer is the computer hard disk, which was first used in 1956, with the Hula Hoop at 2nd in 1958 and AstroTurf, a distant 3rd in 1965.
Where did the first plastic surgery take place? Hollywood? Nope, the first plastic surgery was performed in England in 1814.
Rayon must have been invented around 1970 in New York to clad disco artists in shimmering glamor right? Not quite, it was invented by Swiss Chemist, Georges Audemars in 1855.
The car and the loud speaker…both German.
The tea bag – China? England? Well, that one is all USA – invented by Thomas Sullivan in New York City in 1904.
So what’s my point? Invention and evolution are not the same thing. Significant improvements occur well after conception, often to such an extent that the origin of something is completely lost in its subsequent history. Specifically, when a trillion dollar economy (the annual value of healthcare services in the U.S.) starts to influence Fee for Value systems, we should expect to see a significant evolution in the way those systems are operationalized. Not just in the United States, but everywhere.
IT – Changed for Good?
In a Pay for Service system, you generally have three entities with some shared IT interaction; but the relationship is often adversarial. These entities are:
Insurance companies (payers) want transparency into what services are provided so that they can verify that they are paying appropriately. Hospitals and doctors maintain administrative and clinical systems for themselves, primarily in an attempt to create a more efficient business and a better patient environment. Secondarily these systems are often needed to meet compliance requirements. In neither case is it particularly valuable to share systems with payers or patients, beyond what is minimally required, especially considering the costs involved.
As motivations are aligned around providing patient value, there is a great opportunity to decrease IT and administrative costs as systems and services may be shared. On the other hand, there is also significant risk, as IT is required to extend and expand support to a larger number and broader type of business users – not to mention the need to provide some level of IT services to patients. All of this is on top of the other obligations and changes that IT departments are being required to support globally such as ICD-10, telemedicine, ongoing EHR projects, and extended in-home healthcare delivery.
As with many things in life, these changes both create risk and present opportunity. As ACOs in the United States come on line, billions of dollars will be spent developing and improving IT systems used to service administrators, delight clinicians and engage patients. These systems will have levels of integration and efficiency never before achieved. Whether you work in one of these new ACOs, or in a country where fee for value and single payer have been around for decades, this is an exciting time!
The next ten years will require healthcare organizations around the world to think and deliver IT services differently.
An Experienced Provider
For more than a decade RES Software has provided innovative solutions for the healthcare market in some of the most forward-looking fee for value environments; in fact there are countries where nearly 70% of the healthcare market use RES Software solutions.
At the same time, RES Software has been innovating and implementing innovative solutions in pay for service environments.
They believe that the evolution of fee for value in the U.S. is an opportunity to meld the best of both worlds together, creating groundbreaking solutions for more efficient operations and, more importantly, to create happier, healthier patients all around the world.
If you would like to understand how RES Software delivers IT more efficiently, across a broader range of environments, while