Friday, November 13, 2015

Moving from Information to Knowledge in Challenging Times!

“The species that survives is the one most able to change.”
          Charles Darwin

The healthcare sector is a dynamic and rapidly evolving business model that has new market forces being imposed on it from a variety of directions.  Moving from the historical “fee-for-service”  (FFS)payment scheme to “bundled payments” for a defined period of time after discharge,  is intended to put providers at risk, for both the outcomes of care and the cost of the services provided.   
                In the middle of summer, the Centers for Medicare and Medicaid Innovation (CMMI) announced a mandatory bundled payment requirement for two (2) Medicare orthopedic DRG’s, or the so-called CCJR model.  This payment system is being applied in seventy-five (75) metropolitan locations across the country and is supposed to start on January 1, 2016.

                Currently, CMMI has about forty (40) demonstration projects around the country that are experimenting with numerous systems to reduce costs and enhance outcomes.   Accountable Care Organ1zations (ACO’s) in the form of “Pioneer ACO’s”, original ACO’s and Next Generation ACO’s, are all part of this evolving payment direction.  Even non-acute care organizations are moving into risk-based payment systems.  The CMMI Bundled Payment Care Initiative (BPCI) Model 3 demonstrations that saw almost 1,000 non-acute care providers (skilled nursing facilities, home care providers, and hospice organizations) accept contracts to provide services under a fixed bundle amount.

While some providers and payers have used similar models for non-governmental payers, moving the Medicare FFS to this new model will require move information about the care, costs, and outcomes to the patient by providers.  That will translate into the need for health information systems that creates a value to the organization to provide the ability to move to a knowledge-based decision process.

Darwin’s quote should certainly be considered by healthcare providers as the evolution of the care delivery system moves into the sector.  Those providers that understand the information that will be needed to thrive in this new knowledge environment will most likely be one of the survivors.  Those organizations that fail to see how information is translated into knowledge and make decisions based on the data will have difficulty competing.

Contributed by Steve Chies, MHA, Adjunct Faculty Saint Joseph's College

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