The rollout of the healthcare.gov website in 2014 underscores the critical role information technology plays in transforming health care in our country. Healthcare reform is the engine that drives demand for IT resources, as providers and payers race to comply with a variety of regulatory mandates to transform healthcare delivery to optimize the health of our nation.Through two key pieces of reform legislation - the American Reinvestment and Recovery Act and Affordable Care Act - U.S. law makers appropriated funding to provide access to care for the uninsured in this country. A paradigm shift was required to design a system to manage the health of a nation and to facilitate the transition from a fee-for-service to value-based reimbursement model due to the high cost of care for both insured and uninsured citizens.
Population health is not a new concept, as insurance companies and employers have traditionally had a group model, designed to fund and manage risk of large numbers of people, such as employee populations. Under reform, the insurance model has migrated to the provider side, with increased accountability for transparency and delivering value. Providers are being incentivized to share in the risk and reward in managing the health of their respective patient populations.
In order to attain value and sustainability, this industry is undergoing transformation. As reform progresses, automating provider and managed care organizations beyond the electronic health record (EHR) to identify and engage patient populations, stratify risk within them, and measure and report outcomes will continue, as providers move incrementally toward accountable care. Notwithstanding is capacity to serve, as the volume of new insurance beneficiaries increased by approximately 2 million between November 15 and December 16, 2014. (The numbers for 2015 open enrollment were not available at the time of submission).
While the demand for information technology expertise has grown in response to reform efforts, demand is also expected to rise with enrollment of the previously uninsured; adoption of new enabling technologies to meet current regulatory mandates related to ICD-10, electronic health record implementation, automation of workflows; integration with legacy systems; and a value-based reimbursement system. Going forward, providers will require IT resources to continue this effort, linking provider networks and deploying technologies to effectively manage population health across the continuum of care. Examples of IT activity in this space include:
- Addressing infrastructure needs (hardware, software, and networking for providers and payers)
- Implementation of point of care registries to aggregate and normalize data to gain visibility into patient populations
- Tackling the challenges of data normalization and interoperability across organizations and EHR platforms
In addition, there will be abundant needs in the area of expertise in emerging and enabling technologies to work smarter:
- Mobile and telehealth solutions to optimize patient engagement and cost-effective care
- Building health information exchanges to facilitate appropriate resource utilization and effective care across provider organizations
- Secure data management to assure HIPPA compliance and reduce data breaches
- Analytics and reporting to track and trend population metrics for care optimization, quality outcomes, research findings, compliance, and decision-support tools to optimize clinical and operational effectiveness, i.e. reducing readmissions, patient education program development, and budgeting.
These areas will continue to challenge the healthcare industry over the next decade, at least as healthcare retools and transforms the way they do business to more effectively address population health to optimize the health of our nation.
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