Guest Opinion: Idaho in midst of shift toward wellness and outcomes

Guest Opinion: Idaho in midst of shift toward wellness and outcomes


March 22, 2015

While all of the attention paid to Medicaid expansion is certainly warranted, there are other game-changing health care developments already underway in Idaho. These developments are quietly transforming the industry and improving both patient outcomes and health system efficiencies as we speak.

At the heart of these changes is a shift away from the traditional system of reimbursement – the fee-for-service model – that we all realize no longer works. Health care providers, doctors and hospitals have always been paid or reimbursed based on each service rendered, with less emphasis being paid to the outcomes and effectiveness of those services.

The shift that’s afoot focuses on incentivizing and paying health care providers for delivering high-quality care in a cost-effective manner and keeping people healthy by focusing on prevention and health maintenance. If you think such changes will be slow to arrive, consider this: Health & Human Services has set a goal of tying 85 percent of all Medicare fee-for-service to quality or value by 2016.

How will physicians and hospitals respond? It turns out that in Idaho some have already begun reorienting their practices more toward wellness and outcomes. Primary Health Medical Group (PHMG), for example, has benchmarked its care practices to national standards for several years and rigorously measured outcome data to improve care, manage populations with chronic conditions and determine cost effectiveness. Next, PHMG plans to leverage predictive data analytics to further track value across the entire continuum of care, analyzing claims and outcome data together to achieve improved quality of care and greater efficiency. Their emphasis on better outcomes will be rewarded by both private insurers and public payers like Medicare and Medicaid.

Thanks to the ubiquity of cloud-based applications and the ever-growing power of predictive data analytics to yield useful, actionable insights for doctors, health care systems large and small can take advantage of cutting edge technology to better understand what’s happening with their patients and how they can enhance their care practices to improve patients’ health.

Idaho will continue to move in this direction thanks to the State Healthcare Innovation Plan (SHIP), the result of a six-month planning process. Implementation begins this spring. Key goals include improving care coordination through electronic health records and health data connections, as well as a statewide data analytics system.

In the process, Idaho will be able to improve rural patient access, accelerate the payment transition from volume to value, transform primary care into patient-centered medical homes, and reduce costs. When it comes to health care, information (data) is most certainly power, for physicians, insurers and patients alike.

Michael Hollenbeck is the founder of Boise-based Proskriptive.

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