ATLANTA--Healthcare reform isn’t going to happen in the halls of Congress, but through improved data-driven quality throughout the U.S. healthcare system, said Susan DeVore, president and CEO of Premier, during an educational session Tuesday at HIMSS10.
Noting that business intelligence and technology can focus on how make needed changes within the health system, clinicians should make delivery systems more accountable from a complete perspective, DeVore said.
The underlying premise of delivery system reform is that CMS must transform itself from a passive payor of services to an active purchaser of care while continuing to target unnecessary costs, DeVore stated.
“My biggest fear is that we’ll spend millions and end up with a data dump,” said DeVore.
According to DeVore, 46 million people are uninsured in America and if healthcare reform opens the door for 30 million of them to get insurance, it could be a shock to the healthcare system. The healthcare industry is unprepared for that reality, so even though you’ve “fixed the car, you’ve got more trouble going forward,” DeVore said.
Because the Medicare trust fund is expected to be exhausted by 2016, the healthcare industry is at the point where it is unsustainable. DeVore expects $500 billion to be cut whether or not a delivery system reform is passed into law, which she said will further exhaust the industry's resources. “Improvements aren’t keeping pace with spending,” said DeVore.
Improving quality should involve systematic improvement and progress improvement with a focus on clear measurements, DeVore stated. “There isn’t evidence for all the quality indicators,” said DeVore. Although DeVore said that “[i]f we can agree where harm is, we can improve harm. If we can drill down with business intelligence in IT data, we have half a chance at improving it.”
“Particularly in health IT, we’ve got to get evidence-based medicine where it doesn’t take 17 years to get medicine across the country,” added DeVore.
There are clinical gaps across the healthcare industry that impact delay in care and additional imaging, said DeVore. “What is driving the unexplained variation is what we need from data,” She said there is a potential repository of revenue waiting to be collecting in the following areas:
- Unexplained variation in the intensity medical/surgical services: $600 billion;
- Misuse of drugs and treatments resulting in preventable adverse effects: $52.2 billion;
- Overuse of non urgent ED care: $21.4 billion;
- Underuse of appropriate medications, such as generic hypertensivness, asthma controllers: $5.5 billion; and
- Overuse of antibiotics for respiratory infections: $1.1 billion.
To claim some of this revenue, DeVore suggested value-based purchasing, accountable care organizations (ACO), bundled payments, nonpayment for preventable readmissions, nonpayment for infections, transparency initiatives and attacking waste, fraud and abuse.
“Someone’s waste may be another’s hope,” said DeVore, adding that another test could be hopeful for a chronic condition patient.
“To solve the cost of problems in your clinical condition, we’re talking about all these grandiose ideas, but drilling down is not that easy,” DeVore said. Championing evidence-based cost metrics, DeVore shared the top twelve targets of waste for a composite “waste index:"
- Staffing-premium dollar utilization;
- Unnecessary testing/hospitalization;
- Hospital acquired conditions;
- Nonstandardization of high value items, such as implants;
- Pharmacy utilization –antibiotic selection;
- Throughput (ICD and ED);
- Length of stay;
- Time to implement contracts;
- Medication errors; and
- Contract noncompliance.
DeVore also noted that a lot of investment has been put into an ACO, which builds patient-centric systems of care and improves quality for delivery system components by coordinating care across its members.
Building payor partnerships and accepting accountability of the total cost of care requires building IT and data management across the continuum of care, interoperability to link EMR systems to wire the population so that it doesn’t have to happen in a provider system.
“This model will require more than EMR but the road ahead is the right one,” concluded DeVore.