POSTED ON AUGUST 28, 2013:
The Cutting Edge
Technology may figure in health care reform
Dr. David Kendrick and state leaders -- including those in the insurance industry -- are chasing millions set aside for federal Health Care Innovation Awards.
But a grant application can be successful in more ways than one, according to Kendrick, chief executive officer and founder of the MyHealth Access Network.
"For me, the most important thing about that application is the coalition that came together to put it together," Kendrick said, just a day after putting the finishing touches on the proposal.
The application seems to have further fostered partnerships between the state's Oklahoma Health Care Authority and insurance groups, also known as "payers" in the lexicon of health care policy.
"The application was to create and leverage a community health improvement fund across multiple payers to implement quality improvements," Kendrick said. He hesitated to name the insurers participating, noting disclosure concerns.
But he noted that the MyHealth network already has "pretty significant partnerships" with insurers CommunityCare and Blue Cross Blue Shield, who are participating in an ongoing pilot project in Tulsa that has already received federal grant money.
"Their role in MyHealth is to do what we call prime the pump, that is recognize and reward physicians who achieve quality measures," Kendrick said.
But how to best measure such quality improvements? Kendrick sees the technology used by the MyHealth network as critical to efforts "to get beyond what we call process measurements in health care."
Moving toward health outcomes is a recommendation in the Leavitt report, the document prepared by consultants to guide state efforts addressing the needs of low-income adults without health insurance.
Kendrick noted that the data readily available to insurers is "administrative claims data, the kinds of things that bills are filed on." That information "generally is not the kind of data that indicates whether patients are getting healthier or not," he noted.
Rather than embrace Medicaid expansion, officials seem focused on developing an "Oklahoma plan," in the words of Gov. Mary Fallin.
How exactly such a plan would differ from Medicaid expansion remains unclear. The Leavitt report authors advised the state to still accept federal dollars and provide some form of government-subsidized health care coverage for the roughly 200,000 childless, low-income adults currently shut out of Medicaid safety net programs.
The Utah-based consultants' recommendation to focus on health outcomes may dovetail with Kendrick's role pushing technology to allow for the seamless sharing of information.
"I think most patients are pretty shocked to find out how little information technology has been used in healthcare over the last few decades," Kendrick said. He's led an effort begun in 2009 to create what is known as a health information exchange.
The concept isn't original to Tulsa, but it's still far from the norm nationally. The central benefit of such a network is that doctors can easily access more of a patient's medical records, even if they were created at the office of an unaffiliated health care provider. The goal is "to move data where it needs to be and also to provide feedback on gaps in care," Kendrick said.
By working to sign up major health care providers in the greater Tulsa area and beyond -- aided with $12 million in federal stimulus dollars to help put the program together -- Kendrick now counts almost 100 health care organizations as partners.
Care providers signing up to MyHealth pay a fee to the non-profit coalition, which also accepts funding from other sources. According to the organization's 2011 tax return, the George Kaiser Family Foundation provided about $170,000 in grant money that year, which Kendrick said helped clinics for the needy sign up for MyHealth.
The MyHealth network is "pretty well engaged" in an already ongoing federally-funded pilot project to develop the health home concept, which also involves the Oklahoma Health Care Authority and insurers. This pilot project, known as a Comprehensive Primary Care Initiative, involves a concept of care coordination in which patients are treated by a team of health care professionals.
Apart from that pilot project, the state-run SoonerCare program -- the Oklahoma name for Medicaid -- also has begun what are known as Health Access Networks, according to the Leavitt report. One component of these care-coordination networks is the offering of electronic health records and "telemedicine," referring to remote treatment or diagnosis.
The latest grant proposal -- which could result in an award anywhere from $1 million to $30 million -- could bring some of the concepts that are part of the Tulsa pilot project to the rest of the state, Kendrick said. But it is far from assured of funding.
"It's a very competitive process, but you don't ever get one if you don't apply," Kendrick said, with the result of the application not known for a year or so.
This latest effort presaged the Leavitt report, according to Kendrick. But the data to measure health outcomes is built into the very nature of the MyHealth Access Network.
"I think we've got about 2.4 million patients' worth of data in the system, and we get new patient information at a rate of just over 400,000 clinical data elements a day," Kendrick said.
A blood pressure reading or even just a weight measurement might be considered such an element of data -- and if the goal is to lower hypertension or obesity rates in a population, it starts with having access to such measurements.
"You can't fix something you can't measure," Kendrick said.
Authors of the Leavitt report keyed in on offering financial incentives for improving health outcomes as a recommendation to the Oklahoma Health Care Authority, noting the availability of such federal innovation awards.
"If OHCA decides to move in the direction of linking payment strategies to public health improvement initiatives, it may consider applying for a Health Care Innovation Award as part of a collaborative with other agencies or commercial market entities," the June report stated, noting that the awards are for testing "new payment and service delivery models."
Dr. Brian Yeaman, a family practice physician in Norman, has chaired a committee on health information technology for the Oklahoma State Medical Association, the membership-based organization representing medical doctors.
He praised the further integration of electronic records into medical practices, as well as a federally-mandated push to provide patients with interactive health records.
Yeaman, however, cautioned about moving full bore into payment systems based on clinical measures.
"We don't follow them home and give them their medication every night," Yeaman joked. A greater worry for doctors is the still-patchwork system of data collection, as Yeaman expressed concern that true health outcomes data must be validated and relevant.
Regarding such pay-for-quality initiatives, "a lot of that assumes you have a lot more data on the patient then what we currently have been able to represent," he said.
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