Care To Share
The combination of no sleep, too much caffeine and physical exertion can trip my supraventricular tachycardia wire. That means my heart starts beating twice as fast as normal. When SVT hits, I stop what I’m doing, rest and in less than a minute, my heart shifts back into regular gear. No big deal.
After a long walking tour (preceded by an overnight drive and a thermos full of coffee) of a hilly Big 10 campus where my daughter was considering going to college, SVT hit and stuck around for two hours. I went to the university hospital emergency room. A round of tests confirmed SVT, and they gave me a dose of adenosine that reset my heart. An hour later, we were enjoying 50-cent beer and wing night at the campus sports bar. Despite a great Tuesday-night special, she chose another school. My primary care doctor referred me to a cardiologist to make sure nothing else was wrong. I called the university hospital and asked them to send all my test results to the cardiologist to review before my appointment. When I went to see him, he said he couldn’t find or never got the test results, and wrote orders for the same tests. He also made an appointment for me to visit the cardiac electrophysiology lab, where they use lasers or something to short-circuit certain nerves in your heart to prevent SVT.
The appointment card for the visit and the orders for the tests were in the trash can by the time I got to the medical office building parking lot. (I kept the parking validation.) If he and the hospital don’t have the ability or desire to exchange my medical information to prevent me from redoing the same tests—along with my time and my co-pays and deductibles—no way does he get my business.
Employers should take the same hard-line approach with the providers they send their employees to for medical care. They should only contract with—directly, or indirectly through their insurance carriers—hospitals and doctors that have the ability and desire to exchange patient health information with providers outside of their own system.
Hospitals and doctors like to blame incompatible electronic health record (EHR) systems for the inability to share patient health information. To a large extent, that has been true, at least historically. But the lack of health information technology “interoperability” is being overcome by health information exchanges (HIEs). There are private-sector HIEs, which are proprietary software programs used by a group of providers that can translate patient health information from one EHR to another. And there are public-sector HIEs, which are state agencies or state-certified organizations through which unaffiliated providers can share patient health information.
Minnesota has both types of HIEs, which it calls health data intermediaries (HDIs), and health information organizations (HIOs) (bit.ly/1hgbo80). Starting Jan. 1, Minnesota also began requiring health care providers in the state to have interoperable EHR systems (bit.ly/1gFinY8).
A recent report from HHS’ Office of the National Coordinator for Health Information Technology, which oversees the federal health IT incentive program, documented a big jump in the percentage of hospitals electronically sharing patient health data with providers outside of their own system (see chart).
Separately, a study by the Center for Technology Innovation at the Brookings Institution found that a hospital emergency department that queried its local HIE database significantly reduced the number of lab tests and radiology exams performed on ER patients (brook.gs/1MIyOzO).
With the technical barriers falling, the remaining hurdle is desire. Since medical records have been kept, the provider business philosophy has been “own the records, own the patients.” By not sharing patient health information, hospitals and doctors kept those patients within their own systems and practices, and didn’t lose them to competitors.
Health care consumerism and value-based reimbursement are forcing a change in that philosophy. First, patients want care when and where it’s most convenient for them. Hospitals and doctors that block that convenience will lose customers. And second, providers are assuming the clinical and financial risk for patient populations, regardless of where they get their care. So it behooves them to share patient health information with others to ensure that those patients get the appropriate care in the appropriate setting, regardless of where that setting happens to be.
Employers who pay the health care bills—and who pay higher bills because a lot of care is duplicative and not coordinated—must insist that their contracting hospitals and doctors be able and willing to share patient information wherever their employees receive medical care. It’s smart business. TCB
You can learn a lot about how people use the health care system—and about how well the system cares for people—by looking at insurance claims. That’s the thought behind the creation of state entities called “all-payer claims databases,” or APCDs. Minnesota is one of 14 states with an APCD, according to the APCD Council (bit.ly/1IAA8xB). Commercial insurers selling health coverage in an APCD state are required to report all claims to their respective database. In July, the Minnesota Department of Health said Minnesota was the first state to use its APCD to calculate how much payers, including insurers and employers, spend on health care services that could have been avoided with better management of peoples’ health status (bit.ly/1IHio83). The state used advanced data analytics—“big data”—to figure out that 1.3 million hospital emergency room visits, admissions and readmissions annually in Minnesota are preventable, with payers ponying up $1.9 billion because they weren’t.
That’s the bad news. The good news is twofold. First, by conducting the analysis and releasing the data, the state established a benchmark for preventable hospital care that will pressure the health care system to do more each year to keep people out of the hospital. Second, the state suggested four ways to do that:
- Timely access to primary care services
- Improved medication adherence and management
- Greater health literacy and health system literacy
- Better coordination of care among clinicians, social service providers, patients and families
If your business has $1.9 billion lying around, no big deal. But if you don’t, you have four avenues of attack to stop wasting money on hospital care that could have been avoided.
In March, we talked about employers’ need to know what they’re paying for when they sign on to a “narrow network” health plan. Those plans offer employers lower premiums in exchange for requiring employees to use a limited selection of hospitals and doctors (bit.ly/1ctorQd). How narrow is narrow? Researchers from the University of Pennsylvania measured network size available to individuals buying health coverage through state insurance exchanges (bit.ly/1dggQF4 ). The researchers identified 355 distinct networks available through “silver”-level plans sold by 251 carriers. They said 41 percent of the networks were narrow, which they defined as having 25 percent or less of the office-based doctors in the market. That means patients in those plans couldn’t go to nearly three-quarters of the doctors in their area unless they wanted to pay out-of-network charges for their services. Now you know. And now you know why you need to know who’s in a narrow network before you sign the contract.
David Burda (twitter.com/@davidrburda, firstname.lastname@example.org) is editorial director, health care strategies, for MSP-C, where he serves as the chief health care content strategist and health care subject matter expert.