HHS Aims to Make Healthcare “Better, Smarter, Healthier” with Historic Announcement

Health and Human Services (HHS) Secretary Sylvia Burwell’s recent announcement to tie 90 percent of all traditional Medicare payments to quality or value by 2018 shouldn’t take anyone by surprise. This move has been a long time coming; now, it just has a deadline.

Despite long-time chatter about quality and related initiatives, it’s unlikely to be a smooth ride. As a former hospital administrator, health system CEO and physician, I can appreciate the challenges. Most administrators feel besieged by the onslaught of insurance and Centers for Medicare & Medicaid Services (CMS) reporting measures. But before we get into the pain, let’s back up to remember why we’re all doing this, and how we got here:

“The names of the patients whose lives we save can never be known.
Our contribution will be what did not happen to them.”

A wise man and my former colleague, Donald Berwick, M.D., uttered these words in his role as President and CEO of the Institute for Healthcare Improvement, which launched the game-changing 100,000 Lives Campaign and 5 Million Lives Campaign. These campaigns – the first of which started over a decade ago in December 2004 – set out to improve healthcare quality by rallying hospitals to embrace clinical interventions that could reduce incidents of medical harm and morbidity. And success ensued. When the 5 Million Lives Campaign ended in 2008, over 4,000 hospitals and 2,000 facilities had implemented interventions to reduce infections, medication errors, surgical complications and other issues, resulting in improved outcomes for patients.

Aligning Incentives
It’s hard to argue against improving outcomes. Yet, change of this magnitude can go only so far without financial alignment. Insurance and CMS reimbursements have lagged far behind these ground-breaking campaigns.

But times are changing. In addition to tilting the focus of traditional Medicare payments over to quality, HHS is tying 50 percent of Medicare payments to alternative payment models by the end of 2018, further accelerating the redefining of healthcare delivery.

Change is no longer a question of “when;” it’s the how that’s causing anxiety. Clinical protocols must change. Financial models must be reevaluated as risk shifts to providers. Operations must be redesigned to thrive under outcomes-driven requirements. And all of this must be done with a holistic view toward overall organizational performance.

It’s hard to know where to begin. Data, more so than ever before, will be crucial.

Validating Data to Verify Value of Care
Reimbursements are increasingly married to data, and two key issues will make or break the whole system: accuracy and interoperability.

As I reported in an earlier blog post, CMS made over $60 billion in improper payments during 2013. While there are certainly intentional acts of payment fraud, there is also an abundance of human error in the system, and oversight to ensure coding and billing accuracy is often lacking.

As reimbursements are more closely tied to patient outcomes, accurate clinical data is becoming increasingly critical to providers’ financial performance. Faulty data can impact the accuracy of asset valuation, operational performance assessments and financial reporting, which can in turn lead to lost revenue and value to the communities served.

Equally urgent is the need to make medical information more mobile. As new healthcare delivery models force greater collaboration among providers, and reimbursements are affected by a patient’s entire continuum of care, the interoperability of medical information will be critical. The ongoing pain point of electronic health records must be fixed, and soon, or quality metrics will be nearly impossible to report.

Embracing the New Healthcare Reality 
Change is hard, but it’s important that we don’t lose sight of the finish line. We’re in the midst of truly revolutionizing healthcare to bring the system back to its intended triple aim: improving the health of populations, the experience of patients and the per capita cost of healthcare.