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Summary

Two linked developments this week underline the sense of urgency felt in the US healthcare sector to address the cost, quality, and system fragmentation challenge. A coalition of major healthcare systems, payers, and academic centers launched a healthcare transformation taskforce, and the secretary of the US Department of Health and Human Services (HHS) announced a plan to link 30% of Medicare provider payments to alternative payment models by 2016, increasing to 50% by 2018, and to link 85% of Medicare fee-for-service payments to quality and value by 2016. The detailed implications of these developments for IT are not clear cut, but the general impact is. These goals will require better use of provider, payer, and patient-generated data combined with ubiquitous interoperability and effective care coordination.

The new coalition acknowledges that collaborative change needs to hit the mainstream

Although, like most other government targets, the new HHS payment goals seem unrealistic due to the transformative and complex nature of shifting from fee-for-service to value-based payments, the government and industry consensus on the direction of (faster) travel required is loud and clear. The taskforce’s goal of migrating 75% of its business to value-based arrangements by 2020 is also ambitious, but the five-year time frame is more realistic in terms of the pace of change.

The taskforce also has a clear focus. The group’s initial priorities of improving the Accountable Care Organization (ACO) model, developing a common bundled payment framework, and improving care for high-cost patients address areas that are real current pain points: the ACO model remains in the early development stages, with variable performance; there is a real risk of providers and payers being overwhelmed with multiple, fragmented payment mechanisms; and all providers and payers are seeking to target high-cost patients as a first step in more effective patient segmentation, population health management, and care coordination.

Although there are no explicit technology goals, the use of data and the recognition of poor information sharing are highlighted under the taskforce’s stated principle to “continuously improve access to complete, accurate, reliable, timely data.” The group also recognizes the need for better information flows within and between provider and payer communities.

Appendix

Further reading

2015 Trends to Watch: Healthcare Technology, IT0011-000328 (November 2014)

Author

Charlotte Davies, Lead Analyst, Healthcare

Charlotte.davies@ovum.com

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