mHealth and ACOs: Improving the healthcare landscape

Sapna Dalal

The rapidly changing healthcare landscape is shifting toward a new paradigm for improving the quality of healthcare through Accountable Care Organizations (ACOs). The shift focuses on a healthcare payment system that is based on value rather than volume. ACOs, comprised primarily of physicians and hospitals, operate as a single entity, with collective responsibility for coordinating care for a population of patients. The goal is to deliver high-quality care while reducing total expenditures, decreasing duplication of services and lowering risks of errors and complications.

This will require better communication between physicians and their peers, as well as between physicians and patients. The use of mobile technology to communicate and collaborate in practicing healthcare is revolutionizing how these groups exchange information that is timely, relevant and important. Physicians can make decisions now anytime and anywhere about a patient or episode of care.

As the ACO movement is still going strong and the Centers for Medicare & Medicaid Services recently announced 89 new ACOs to the Medicare Shared Saving Program (bringing the total number of participants to 154) what does this mean moving forward? In what ways can hospitals and physicians begin to better communicate and collaborate to bring down the costs and increase quality? How will mobile technology impact these changes?

Here are several ways:

Telemedicine and remote telemonitoring
The concept behind telemedicine is very basic – to connect patients to physicians who can provide care from a distance. While earlier models of telemedicine mostly focused on a physician connecting with a rural patient through the telephone, modern telemedicine is becoming more expansive to include emails, instant messaging, video conferencing and apps on mobile devices.

One area in particular that offers the potential for impact is in emergency room use. A recent CDC report showed that 80 percent of adults between the ages of 18 and 64 who visited an emergency room during the first half of 2011 did so because they lacked access to other providers. Telemedicine has the capability to provide more access for some of those adults through mobile technology for on-demand care that, in turn, uses a physician’s time wisely. If those adults are among the patients in an ACO population, the goal will be to keep those patients out of emergency rooms in an effort to reduce costs.

When a patient with a computer or smartphone can express health concerns by taking a picture of the wound or explaining symptoms to physicians or nurses before coming into a hospital, that healthcare provider could help evaluate whether emergency care is needed. Even an EMT may use mobile technology to communicate with the ER through real-time video to deliver care.

Other examples include patients inputting their health and biometric data into smartphones from monitoring devices that measure parameters such as blood sugar, weight and blood pressure. This information then can safely integrate into the electronic health record (EHR) for instant feedback and communication from physicians and other healthcare providers, even during off hours.

Telemedicine in the mobile space is becoming more scalable and aiding in reducing costs, improving efficiency and supporting a higher quality of life, particularly for the elderly and disabled. It is the right mix of proven technology and clinical care and has the ability to reduce potential liability and penalties in the ACO model from unnecessary readmissions.

Physician engagement
Physician groups, particularly independent practice associations, are increasingly taking the lead in ACOs. While physicians are assuming these new roles and levels of responsibility for efficient, economic-minded care, new models are emerging to give physicians more control over how they get paid and what they get paid for. These may include reimbursements for e-visits, federal incentives for showing certain levels of adoption and even indicating a patient’s willingness to embrace mobile health technology as a method of receiving medical care.

Physicians who participate in shared savings models and deliver on the promise of improved care could garner greater visibility within their community, translating into increased hospital market share. But physicians must be able to document superior, patient-centric care and be savvy about making patients, potential patients and referring physicians aware of their achievements. This can only be achieved by having a robust IT and mobile platform to provide access to the kind of information needed to manage the patient population at the point of care.

Additional benefits of physician engagement with mobile solutions include:

• Reduced readmissions. Mobile devices can help physicians access data and communicate from anywhere, allowing quicker response time to patient needs and services. This in turn could help reduce unnecessary readmissions by managing chronic diseases better. An acute care episode can be managed quickly and efficiently after discharge to have as few complications and readmissions as possible.
• Increased physician loyalty and satisfaction. When a physician has real-time access to his or her patients’ hospital data from a mobile device, there is a higher probability for physician satisfaction and even the potential for increased loyalty for services at the hospital.
• Increased bill capture. The ability to enter billing data immediately after seeing a patient has the potential to significantly reduce the likelihood of lost charges.
• Documentation improvement. Mobile devices could allow more complete documentation at the point of care.

This would not only allow for improved quality of care, but also more appropriate and timely reimbursement.

Patient engagement
Patient engagement and communication will be a cornerstone strategy to manage and control patient information and readmission rates. Hospitals will continue to use traditional forms of communication, but will also need to explore and plan for the use of mobile technology to disseminate information. Health IT products can help engage patients in health-related decisions and management of their own personal health information through various technologies. Automated communication systems can encourage patient engagement and at the same time, assist healthcare providers in meeting their quality and cost goals to manage populations of patients in the ACO model.

EHRs typically offer a patient portal and are one example of a tool that has proven effective in increasing patient and doctor communication, increasing patient safety and helping in coordinating patient care. While the EHR allows for care coordination among multiple providers with continuous flow of information, the patient portal can allow shared information to the patient such as medications, allergies, diagnostic results and hospital stay information.

A Kaiser Permanente study looked at the effect of patient-physician communication through email among more than 35,000 patients with hypertension or diabetes or both. The study found that over a two-month period, the more email activity undertaken by the patient, the more likely he/she was to see improvements in health, such as better control of glucose or lower blood pressure readings. The study also indicated statistically significant improvements in patient conditions.

Provider organizations need to focus on a patient-centered approach when implementing these technologies and look to ways to better manage these populations through increased quality of care, reduction in readmissions and a seamless flow of information that the patient can access and use.

Interoperability
One of the most essential elements of any ACO is an electronic health information exchange (HIE) that allows key stakeholders to share information across the organization and across the continuum of patient-centered care. Seamlessly sharing information can help ACOs further coordinate care, mitigate risks and improve outcomes while continuing to monitor and reduce the cost of care.

Managing care through critical transitions between locations (including physicians’ offices, outpatient surgery centers, hospitals, rehabilitation facilities and nursing homes) is possible through interoperable mobile solutions and requires data-sharing through providers. Actionable data is the key to being able to address concerns and issues, especially at the point of care.

Aetna and Phoenix-based Banner Health are joining forces to develop mobile solutions to address their evolving ACO partnership. The two organizations are seeking ways to reduce costs and improve outcomes and are developing a hefty "technology stack" into the ACO system to improve physician-patient coordination of care. The cutting-edge technology includes not only an HIE, but other mobile solutions to address sharing of real-time information.

These include:

• Health information exchange technology from Medicity to enable the secure, two-way exchange of health information across a patient’s entire care team, including hospitals, physicians, labs, pharmacies and other ambulatory services.
• Active CareTeam from Active Health Management to give physicians access to CareEngine which is a powered, point-of-care clinical decision support service and a desktop-based workflow tool to track, monitor, coordinate and report on patient health outcomes.
• Smartphone and online appointment setting and pre-registration services for patients through iTriage, one of the most downloaded health and fitness apps in both the iTunes App store and Android market.

These technologies can help join clinical and claim information to create a broader patient record available to the entire care team. The integration of evidence-based intelligence, workflow tools and care management services to help physicians monitor, measure, coordinate and improve patient care can be achieved through sharing of data and access of information through these real-time mobile solutions. Mobility will help ensure that the most important messages or prioritized tasks are delivered to the proper user or system.

As CMS’ final rules are implemented, ACOs will continue to evolve and adopt mobile technology to address pressing issues for the patient populations they manage. The driving force will rely on keeping the hospital, provider and patient with up-to-date information and communication. CMS’ rules will incentivize ACOs to follow proven practices and show care improvement through evidence-based practices in keeping patient populations healthier. Meeting cost-saving targets will allow the ACO to share in the savings as long as national quality standards are met. For those who fail to meet the targets, financial penalties may ensue.

Sapna Dalal is a healthcare business professional, technology advisor and implementer with more than 12 years of product development experience in the health IT industry and consulting experience with hospitals and health systems. She holds a Masters of Health Services Administration from The University of Michigan and a Bachelor of Science from The University of Wisconsin-Madison.