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The Truven Health Blog


The latest healthcare topics from a trusted, proven, and unbiased source.


Doctors and Data: Working Toward the Triple Aim


By Michael L. Taylor/Thursday, July 10, 2014
Mike Taylor imageChange is rapidly occurring in most aspects of the delivery of healthcare in this country. One of the most promising developments is the understanding that healthcare should strive to achieve the “Triple Aim” – better care for individuals, improved overall health of our communities, and lowered costs. The Triple Aim goals are about delivering better value in healthcare, not just delivering more care. The implications for our healthcare providers are enormous and may represent a fundamental change in the way care is delivered and paid. And the data needs are far greater than before – this represents a major challenge.

Many experts are advocating for new data steams to help find people at risk for diseases, even using non-traditional types of data, such as credit card purchases or use of social media, to define risk levels. Privacy advocates are adamantly opposed, and these debates will continue. Many employers have used medical claims data to understand population risk, but even using these data is worrisome to privacy advocates. Recent federal government revelations about NSA data probes into personal lives have generated much criticism, and I think the outcome will be more controls over the use of data. I think the “new data streams” will be narrowly defined. But the good news is new healthcare delivery models are finding ways to effectively use data to improve patient care.

In the new models of delivery, as seen in the patient centered medical home concept (PCMH), a healthcare team, captained by the physician, now has the responsibility to care for a defined population, not just the patients who show up for an appointment. Physicians are financially incented to provide better care. This drives the need for data, and health records need to find “gaps in care,” such as overdue cancer screening exams and missing lab tests. A PCMH team member is empowered to reach out to patients to help them get the care that is needed. The team is responsible for (and incented to provide) the healthcare needed in all phases of a person’s life. This requires integrated data from all settings – all outpatient encounters, hospital data, and follow-up care, including rehabilitation and nursing home and hospice care. Integrating all these data together will have tremendous potential to improve care. As an HIE contractor, we have constructed platforms that are delivering this kind of integrated data, so we know it’s possible today, and we’re working with hospitals toward the same end. Data integration will be necessary in order to understand when high value care is being delivered by hospitals, physicians, and all healthcare providers.

But more than finding gaps in care; the new model incents better care. Take a simple example of diabetes: the medical evidence shows lower mortality and morbidity in those who achieve blood pressure, lipid, and glucose control compared to those who are not well-controlled. New payment methods will pay physicians at a higher rate when their patients achieve better control of their diabetes. In this scenario, payment is more complicated, and now lab data must be analyzed to determine payment.

Paying more for better value has promise, but also many challenges. Defining better care for diabetes can be done, but what metrics should be used in other conditions?  Physicians see literally hundreds of different conditions in the course of their work with patients; how should higher value be defined in other medical and surgical conditions? Is there value is ordering appropriate radiology exams and forgoing inappropriate tests? How can that be measured and compensated?

Medicare policy is driving much of the change in payment mechanisms, but large employers are also asking about value. Employers are tired of paying for medical treatments that don’t work or are unnecessary, and are looking for cooperative relationships with providers to incent better care. Hospitals are adjusting to focusing on providing better care, not more care. The transition is turbulent, but the result has the potential of achieving the Triple Aim. We will not achieve these results in a fee-for-service system. The changes we’ve seen in healthcare over the last decade are the start of real reform that is badly needed, and we need to continue driving change toward a higher value system. Innovative use of new data streams is vital to this effort.

Michael L. Taylor, MD, FACP
Chief Medical Officer

The Expanding Role of Pharmacists: Out of the Basement and Into the Spotlight


By Tina Moen/Wednesday, June 18, 2014
Tina Moen imageWhat does it mean to be a pharmacist in 2014? I recently presented at the Health Connect Partners Spring Pharmacy Conference to a room full of pharmacy leaders from across the country. We discussed the evolution of the practice of pharmacy, the things we have seen change over the years, and the opportunities (and challenges) we see on the horizon. Throughout the conference, many attendees shared stories of how their responsibilities as a pharmacist have evolved throughout their careers. Our conclusion is that now – more than ever – there are visible, meaningful changes to our role as it relates to patient care, collaboration with our peers, and in leadership participation in the healthcare community.

Clinical pharmacy services, as we know it, are a result of continuous evolution of the historical pharmacy role – namely dispensing medications from behind the counter or in the basement. This evolution has taken many years. Pharmacists now deliver enhanced value to their organizations and their patients with a focus on quality, safety, and efficacy of medication therapies. Programs such as enhanced Medication Therapy Management continue to highlight the impact pharmacists can make on reducing adverse effects and improving efficacy of a patient’s medication regimen. Additionally, pharmacists contributing to Medication Reconciliation and specialty services, like Anticoagulation or Diabetes Clinics, continue to demonstrate that rounding out the care team to include a medication specialist improves patient outcomes and enhances the practice and performance of clinical peers. And recently, I have seen emerging cross-functional leadership teams working toward goals such as the IHI “Triple AIM,” begin to include Pharmacy; tying personal goals and incentives for DOPs to these efficiency and quality objectives.

Clearly, great progress has been made in the practice of pharmacy, and I for one am proud of the role pharmacists play in enhancing the patient experience and outcomes. So, what's next? Here are the things that come to mind when I ask myself this question.

Healthcare IT
A recent article in Healthcare IT News advocated for pharmacists playing a larger role in EHR strategy. As a pharmacist who works within the healthcare IT industry, I couldn’t agree more. What percentage of patients in a hospital has at least ONE medication order? I would venture to say “most.” It’s an obvious conclusion that the profession charged with the safe and effective use of medications should have a significant role in the development, selection, and implementation of tools used to properly care for those patients. And then there is Meaningful Use. How many of the Meaningful Use Objectives are related to medications and the services in which pharmacists participate? Who better then to take the lead in organizational efforts for Stage II attestation and Stage III planning?

Care Collaboration
Cross-departmental coordination for initiatives that span hospital leadership continues to grow in scope and importance. Benefits of pharmacists as integral members of rounding teams within the inpatient setting are well-documented. With organizations designing and implementing Population Health and ACO strategies, pharmacy leaders can capitalize on the combination of data analytics and clinical insight that are the hallmarks of pharmacy practice. As Population Health initiatives evolve – who better than a pharmacist to guide trends in medication recommendations in treating high-risk conditions and ensuring safe, cost-conscious practice remains top of mind?

Quality Patient Care
Providing quality patient care has always been a focus of healthcare providers. Today’s environment adds a variety of incentives and penalties to drive quality. How are pharmacists contributing? In many ways! Pharmacists are well-suited to lead the charge on initiatives like Antimicrobial Stewardship, a quality and a cost management initiative. The importance of medication education and adherence in the improvement of HCAHPS scores and the reduction of readmissions are additional examples how pharmacists can and should use their skills as medication specialists to drive improved patient care. Because results summaries from nation-wide HCAHPS surveys indicate that Medication Safety and Pain Management questions are still amongst the lowest performing areas – shouldn’t pharmacists’ input at the patient care level be paramount?

As I said during my visit to Health Connect Partners, it’s good to look back occasionally to see the progress that has been made and to help motivate us for the challenges and opportunities ahead of us. What is next? What have I missed? I would love to hear from my fellow pharmacists on where the practice of pharmacy will be in the next 10 years. What are you doing today to move the needle in the evolution of pharmacy?

Tina Moen, PharmD
Chief Clinical Officer

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