Data-driven healthcare reform

May 20, 2011

The Washington Post offers a terrific overview of key provisions of healthcare reform legislation and how it came to be.

The Post’s analysis identifies a central mandate driving provisions of the legislation: coordinated care, particularly as directed by primary care physicians.  Judging from Medicare’s longtime role in driving payment reform (see Medicare Prospective Payment and the Shaping of U.S. Health Care, by Rick Mayes, Ph.D., and Robert A. Berenson, M.D.), the $26.4 billion being made available in part through the Centers for Medicare and Medicaid Innovation represent a significant sea change for U.S. healthcare policy aiming for better outcomes at less cost.

In addition to the formation of accountable care organizations and patient-centered medical homes, the Patient Protection and Affordable Care Act sets new priorities, and funding to back them, and substantially encourages the development and growth of effective primary care.

Extracts of significant data that led to these initiatives:

  • States with a higher per-capita ratio of primary-care physicians have lower mortality rates from cancer, heart disease and stroke.
  • Having one additional primary-care physician per 10,000 people was associated with a 6 percent decrease in total mortality and a 3 percent decrease in infant mortality and low-birth-weight babies.
  • In 2000, 5 million hospital admissions, costing a total of $26.5 billion, might have been prevented with better primary care.
  • Any physician who was treating an average of 264 Medicare patients had to interact each year with 229 other physicians working in 117 different practices in order to serve those patients.
  • Readmission rates in elderly patients dropped by nearly half with a basic program that featured frequent phone calls, home visits from transition coaches, and a medical record maintained by the patient.

The above data provide a glimpse of the enormous opportunities ahead for bringing healthcare fully into the 21st century, a shift Dr. Tom Ferguson referred to back in 1995 as the shift from “industrial age” to “information age” medicine.

The question now being asked at the cutting edge of healthcare policy and technology development: What information technologies are capable of producing transparently coordinated care?

With current EHR implementations relying upon information architectures dating back to the 1970s (and lacking features such as the ability to meaningfully interpret time-based data), the answer is not entirely obvious from within the IT departments of even the largest and best-equipped healthcare organizations.  Traditionally, health records have been held by the care delivery organization (including small practices) as a business record, so it has seemed until now that legacy transactional systems made sense.

But now Congress, through a significant amount of hard-won federal funding, is saying to the healthcare profession and the entire IT industry, in effect: What can you do to enhance the knowledge processes of medicine, and among all the players in any one patient’s care?

This is a completely different challenge than the one that has already been met by conventional IT over the past 40+ years, and where the emergent opportunities are to be found.