Last week, Matt Adamson, vice president of MEDecision’s Interoperability Competency Center joined Dr. Joe Nicholson, Chief Medical Officer of Blue Cross Blue Shield of Oklahoma to conduct two outstanding sessions at the IDC Health IT Insight Summit conference held in Savannah entitled “Using Technology to Facilitate the Medical Home.” They presented a case study of a patient centered medical home pilot project BCBSOK and MEDecision are currently working on for Oklahoma. Matt and Dr. Nicholson provided excellent insights on the details of the initiative, particularly the obstacles that may have to be overcome in planning and execution, and an insightful analysis of its anticipated benefits.  

The presentation was met with great enthusiasm by those in attendance which I think is due in large part to the role that the medical home model is anticipated to play in supporting health care reform efforts. The concept has clearly been gaining significant traction and momentum over the past year or two and, as the MEDecision/BCBSOK pilot exemplifies, has outstanding potential to bring increased efficiencies and cost containment to the system. As Matt and Dr. Nicholson explained, incorporating technology into the equation makes the model even more promising. In addition to facilitating more streamlined communication between care team members, IT will give each care provider consistent access to actionable clinical data along with the ability to input information generated from ongoing patient interactions that can help streamline reporting and tracking for quality assurance measures. The existence of clinical decision support and structured disease management programs will improve quality and foster better outcomes.  

The patient centered medical home model of care is a foundational approach to positively transforming health care delivery. As the MEDecision/BCBCSOK pilot progresses, we will update you on how leveraging technology augments efficiency, effectiveness and quality outcomes. It will definitely be worth keeping an eye on this particular pilot project and the overall progress of the medical home concept in the coming months.

Senator Max Baucus’s strategy to push forward with his long-delayed health care reform plan without any support from his Republican counterparts reeks of politics-as-usual in Washington. It’s ironic that it came a mere seven days after President Obama urged bi-partisan cooperation, openness and collaboration in his reform address to Congress. Perhaps the Democrats who believed that Senator Grassley was simply stalling and not negotiating in good faith had it right all along. 

The myriad implications of Senator Baucus’s decision to move along with his plan without Republican buy-in will undoubtedly be debated and analyzed ad nauseum by the cadres of pundits, talk show hosts and government commentators on both sides. A good many of them are likely to assume (and perhaps accurately) that Baucus’s stubbornness is a sign that compromise season is over in the nation’s capital and, therefore, that progress on true reform in and of itself will slow or even stop. And I would be willing to bet that a good many talking heads will believe that the existing health care establishment will breathe a collective sigh of relief and proceed to crack open the victory champagne.  

Wrong. 

One of the things that has gotten lost in all of the debates, bickering and controversies is that the health care industry itself is welcoming, if not hoping for, reform. Each of the various entities with a vested interest in how our system works is fully aware that it doesn’t work well for all of us (after all, their employees, families and friends are patients, too) and has an express, legitimate interest in helping to improve it. Naturally, not all of constituents necessarily agree with every aspect of every various proposal. Most (rightfully) have concerns about how particular plans and ideas will ultimately impact them, but in general all parties are eager to see meaningful and sustainable change that fosters a simpler, more accessible and affordable system for us all.  

So there won’t be any high-fives and chest-bumps among health care industry executives should the whole reform thing go to pot. Just a lot of people, like their fellow Americans, saddened to see political shortsightedness and vitriol once again hamstringing progress.

My esteemed colleague, Dr. Alice Petrulis, Chief Medical Officer at KePRO, and I collaborated last Wednesday on a webinar discussing how KePRO has implemented MEDecision’s Nexalign iEXHANGE to reduce its overall cost-per-review and increase provider satisfaction through rapid turnaround. The company has really done some very innovative work with Nexalign iEXCHANGE on this project. It first implemented the approach with one customer in 2005 and by 2008 it had resulted in more than 90,000 auto-approvals and a cost savings of $250,000. As Dr. Petrulis explains in the webinar, KePRO is now extending the procedure throughout across its organization.

You can link to the webinar archive here.

MEDecision’s Vice President of Content Development Marie DiPrinzio joined Dr. Lavdena Orr, the Chief Medical Officer at DC Chartered Health Plan in Washington D.C., and the plan’s Senior Director, Rosalyn Stephens, for a presentation at the recent AHIP Medicaid Conference. The three discussed how Chartered has successfully implemented MEDecision’s Alineo collaborative health care management platform to manage care for its rather challenging Medicaid population.

Some of the difficulties in managing Medicaid patients stem from the fact that they are frequently transient; they may change addresses regularly or be homeless altogether. In addition, as a rule, Medicaid members can change their insurance coverage monthly, so they often bounce in and out of Chartered’s system. Chartered’s population is also culturally diverse and sensitive, representing different ethnic backgrounds, cultures and languages; many have limited resources.

With Alineo, Chartered is better able to manage its members simply by being better able to keep track of them. The technologies provide a centralized view of each patient that is available to care team members no matter how frequently or infrequently a specific member has touched the Chartered system. They have at their fingertips a comprehensive view of prior visits, existing conditions, treatments, medications, tests and so on, all in one centralized resource — no need to access a variety of systems and technologies. Chartered has also found that Alineo has allowed it to improve communication internally and with providers and other entities. In some instances, the system can help to facilitate communication between the care team and a patient’s caregiver even if the individual patient can’t communicate themselves. 

Chartered’s experience with MEDecision technology is a fascinating case study and an excellent example of how information technology can improve health care management and delivery. Apparently the 60 or so payer attendees at the presentation agreed as each was very well engaged in an energetic follow up conversation. Congratulations to Marie, Lavdena and Rosalyn on a job well done.

When South Carolina Congressman Joe Wilson shouted “You lie!” during President Obama’s address to Congress last week, he not only displayed incivility and boorish disrespect for the leader of our nation, he also exemplified the need for us all to pay very close attention to the specifics of the language being used to advance the health care reform debate. Whether it’s the result of crafty semantics on behalf of some or selective hearing on behalf of others, we’ve been getting so distracted by the rhetoric that we’re often clearly missing the message.

In his address, the President stated: “There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms I'm proposing would not apply to those who are here illegally.” And this is when Wilson launched his sophomoric outburst. What Mr. Obama said was absolutely, 100 percent the truth: his reform plan in no way, shape or form provides insurance coverage for people who are in the country illegally. However, as some may recall, the law that President Reagan championed in the 80s makes it illegal for anyone seeking care in an emergency room to be denied services because they are uninsured. Therefore, regardless of any proposed reform legislation, illegal immigrants can get treatment. Apparently, when Mr. Obama said “insurance coverage” Congressman Wilson somehow heard “receive service.”

Similarly, earlier in his address the President stated: “…if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.”  Again, a true statement — on the surface.  As I explained in an earlier blog, the proposed legislation wouldn’t directly require anyone to change anything, as the President stated. However, in many cases there will be myriad incentives, financial and otherwise, that could convince employers to significantly change or drop their existing health plans. In that case, individuals working for these organizations will indeed find themselves with different coverage and/or having to change doctors.

As we move ever closer to a reform bill and its eventual passage — which I believe to be inevitable at this point — it would behoove us all to listen very carefully to the various issues being discussed, particularly the most controversial ones. We could all learn a great deal from that which is being said — or not said.

In a recent article on the San Francisco Chronicle’s Web site, Dr. Deepak Chopra speculates that a lot of what’s wrong with health care today can be attributed to the false notion that more is better. As a society, Dr. Chopra suggests, we’ve come to believe that by undergoing more tests, receiving additional procedures, taking more drugs and seeing more doctors more often, we’ll be healthier. He offers myriad statistics to support this theory; numbers which clearly highlight the inefficiencies in our health care system and underscore the need for vast improvements.

Dr. Chopra’s statistics also make clear the need for the increased use of technology as part of our reform efforts. With proper evidence-based clinical support and intelligence tools, physicians would be better able to determine medical necessity, which would help to lower the number of unnecessary procedures and the growing costs associated with them. With electronic medical records providing a more complete picture of a patient’s medical background, it’s likely we could forego certain tests, medications and specialist visits. With a greater breadth and depth of patient information readily at hand clinicians could more quickly and assuredly make more informed decisions. That alone would support operational efficiencies and result in considerable savings.  We can also extend technology to better educate patients and enable them to make more valuable contributions to the decision making process. With greater knowledge, they themselves can help decide whether or not a certain test or procedure is in their best interest, or if the rewards of a certain medication are worth the potential risks, and so on.

These types of technologies are readily available and, given the potential return on investment, are relatively inexpensive to implement. While the debates in Washington and around the nation continue to focus on health insurance reform, it is important for all of us to understand that there are other, far less controversial and polarizing ways to generate health care reform. Technology is quite possibly the most promising and certainly a strategy through which we can begin making inroads while we argue the details of a more comprehensive plan.

A recent op-ed piece in the New York Times describes “A Public Option That Works” for health care in San Francisco. Briefly, the city has enacted legislation that creates the Healthy San Francisco program which deploys a medical home to coordinate care at designated public clinics and hospitals within the city. Low income participants receive heavily subsidized access while others have the option of participating in the program at rates lower than they would pay for an individual private insurance policy. The NYT article itself provides further details, including the structure San Francisco has devised to pay for the program.

Whether or not the Healthy San Francisco model would work on a national scale is open to debate, but if nothing else it proves that there are different varieties of “public options” out there and that each can mean something radically different. In other words, it’s rather disingenuous for those in Washington to propose a Medicare-like public option as the only option. It’s also a bit premature for any of us to support or oppose a public option until we learn the specifics of what a particular proposal actually entails. All of this underscores the need for cooperation. Perhaps we can take elements of a number of ideas that might not work on their own and combine them into one that will. Maybe with some rational objectivity and bi-partisan input we could devise an altogether new strategy that’s better than any we’ve seen so far.

As with so many other aspects of health care reform, there are many ways to approach the public option. We owe it to ourselves to consider all of them. Or to at least recognize that they exist. Personally, I don’t believe a federally-run public option is necessary or helpful, but as the issue continues to stir emotions and prompt heated discussion, we should at least know what it is we’re debating.