In today’s sharply divided political landscape, the rancorous ongoing debate over healthcare policy yields very few propositions that garner widespread bipartisan support among the nation’s policymakers. Yet here is one broadly supported proposition: to reduce the cost of care while increasing both quality and efficiency, care should be coordinated across the myriad settings in which it is provided.
From fans of the Affordable Care Act (ACA) on the left to acolytes of the libertarian CATO Institute on the right, this basic notion of “care coordination” occupies a central place in most every credible health reform proposal out there. Yet a half-decade into the age of the Accountable Care Organization (ACO) broad care coordination remains more aspiration than reality, in part because modern information technology remains woefully underutilized in healthcare.
The key ingredient to successful care coordination is sharing of patient information. A care provider with access to her patient’s full care team and entire medical record does not order redundant or unnecessary tests. She does not waste time and effort taking a patient history before every care encounter. Most importantly, she makes far fewer errors than do providers who lack a full view of their patients’ healthcare. Health information technology (“health IT”) is the delivery mechanism for this all-important information exchange.
To-date, policymakers have taken an unnecessarily limited approach to spurring care coordination. Value-based payment models, such as Accountable Care Organizations (ACOs) created by the ACA, are meant to create new contexts in which providers entering into particular partnerships can jointly share in the cost-savings generated by broad coordination of care. That is fine so far as it goes, but by defining specific contexts in which care coordination is enabled, government has in effect decreed that coordination shall occur within the confines of closed, federally approved bureaucratic structures, but not outside of them and not between them. This leaves a lot of potential savings and efficiency on the table.
Worse, the advent of these models has accelerated consolidation in healthcare. The administrative burdens of participation in, say, an ACO requires management by a full team of administrative and business personnel. This leaves the nation’s independent providers with an untenable choice: forego independence and join an ACO, or forego participation in the important movement toward coordinated, high quality, and lower cost healthcare.
In truth, as anyone carrying a smartphone intuitively understands, the IT necessary to broadly coordinate care exists and is available to providers. What is lacking currently is the legal flexibility necessary to allow technology providers to empower care providers to both remain independent (if they wish) and coordinate care without assuming the burden of a large new organizational bureaucracy. This is the problem that our Independent Risk Manager (IRM) proposal, recently recognized by the Pioneer Institute with a Better Government Award, seems to address.
The technological proposition is relatively simple: non-provider organizations should be able to use modern health IT to manage patient and claims data on behalf of care providers at low cost and independent of any administrative structure, empowering those providers to practice in the environments they choose.
The policy proposition is even simpler: the exemptions and permissions that currently allow for successful care coordination within specific contexts should be extended to allow coordination broadly.
We are honored by the Pioneer Institute’s recognition, and hopeful that it will bring the IRM to the attention of policymakers inclined to put some regulatory flexibility behind that rare bipartisan policy imperative.