With the evolution of primary care management networks and ACOs, health care providers will need to implement new technologies. Technologies will reduce the incidence of risk by minimizing the human variation when we talk about consistent, predictable, and now accountable performance over time. It is the variation in behavior of health workers and providers that create the risk of errors and mistakes in the daily provision of health care services.
We all know that the inability to effectively manage the care of the patient across different levels of service is one of the main reasons health care providers fail to routinely manage care and control costs. In the past, there was no effort to create the care management networks that are evolving today across the country.
The elderly, chronically ill patient was being managed in silos, depending on their current health care condition. There was really no way to monitor and know when a patient was having a change of condition. When the patient had an exacerbation of their chronic condition, off they went to the hospital’s emergency room. Then, they were admitted, stabilized, and sent back home for the next round. The circle of care was endless. It’s no wonder the cost of health care was out of control.
What we know today is that the whole premise behind the evolution of primary care management models being piloted within care management networks is predicated in large part on preventing a change of condition of a patient no matter where they are in the network. It is also predicated on “catching” this change as it happens. Then, providers must take the care to the patient as opposed to transferring the patient to a higher, more costly level of service.
The fact that there were no incentives for hospitals and/or physicians to control or contain utilization costs was a major reason providers had difficulties care managing large patient populations in defined regions. These groups were working in silos, driven to maximize reimbursement and income. It wasn’t until the federal government financially penalized hospitals and physicians for avoidable re-admissions, that we saw a change in practice patterns.
Because of these issues, we are now seeing the evolution of primary care management delivery networks across the country, some as ACOs, some pilots, and others in similar network delivery models. To be effective in primary care management networks and properly manage patient care in the network requires three essential “technology must haves”:
1. Network-wide electronic health records. It’s critical to have electronic records that can be accessed by all pertinent providers, at all levels of service, no matter where the patient is in-network. The key is that access has to be network wide. Communication is especially critical in consistently preventing the change of condition of the patient over time.
2. Telemedicine at the bedside and in the home. Every caregiver needs to have the ability to communicate with primary care physicians and mid-levels when they are at the patient’s bedside. This can be both in-patient or at home. If a change of condition is to be identified before it becomes exacerbated, then providers need to know the daily status of the patient -- no matter where they are in-network. Telemedicine technology can make this happen.
3. Electronic staffing and labor management systems. The ability to effectively manage staffing patterns by mix of RNs, LPNs, and caregivers to acuity and volume fluctuations is critical. Moreover, all post-acute providers – skilled nursing centers, assisted living facilities, home care and hospice services, primary care centers—need to have this ability to manage staffing. The possibility for shared staffing can be endless with an integrated system that can adjust staffing needs real-time as needed.
As a post-acute care provider, think about where you are in your technology strategy. What challenges are you, your partners, and your patients experiencing due to heavy, timely, complex manual processes? Your role in accountable care is critical and how you leverage technology can be a game-changer.
I’ll leave you with that thought for now. In my next post, I’ll explore the very real leadership opportunity post-acute providers have in technology adoption in accountable care.
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