It’s a phrase we hear over and over: Our nation’s commitment to health information technology (HIT) is not really about the technology, it’s about the improvements in health care and health outcomes that the technology can support. When the Health Information Technology Economic and Clinical Health Act (HITECH) was enacted last year, the aim was not merely to support adoption of electronic health records (EHR), but rather to lift health care to new capabilities and to support effective new approaches that will translate into better health for Americans.
Of the several different programs created by HITECH, the Beacon Community Program is perhaps the one that most conspicuously illustrates the transformational potential of health IT. The seventeen Beacon awardees in diverse communities across America will showcase specific ways that health IT is being used to support individual providers in delivering improved care to their patients, but also in providing new tools for consumers and whole communities in effectively tackling their most pressing health care problems.
While technology is at the core of each Beacon Community, none of the Beacon projects start by aiming to merely enhance IT capabilities or achieve other technological goals. Rather, groups of leaders in each Beacon Community start by identifying the community’s most pressing health problems, and then articulating a vision for what they want their communities to look like in three or four years after they implement a range of initiatives and interventions to achieve that vision.
Rounding Out the Beacon Portfolio
The final two Beacon Communities were recently announced following a highly competitive process that included many strong proposals from across the nation. The Greater Cincinnati HealthBridge and the Southeastern Michigan Health Association were chosen because they proposed clear, logical, and compelling plans for specific interventions expected to measurably improve outcomes, all building on a foundation of health IT.
Specifically, community leaders in Cincinnati examined local rates of diabetes among adults and asthma among children and concluded that it is possible to use health IT to make targeted improvements in both. In the context of improving pediatric asthma, Cincinnati leaders proposed specific measures and targets that characterize how they will track progress, including increasing the number of high-risk patients receiving evidence-based care, reducing the number of asthma-related hospital admissions and emergency department visits, increasing the number of pediatric asthma patients receiving appropriate immunizations, and others.
With these performance goals and measures in mind, Cincinnati leaders designed a multi-faceted strategy to securely share health records among care managers, physicians, hospitals, and other partners in the community to track and coordinate care wherever patients seek it; develop registries to identify and monitor the health status of particularly high-risk asthma patients; deliver real-time performance feedback and new clinical decision support tools to physicians to take advantage of the latest evidence on ways to avoid asthma exacerbations for high-risk patients; provide education and support to engage patients and their families; and in general, equip a smarter health care system to intervene earlier when complications arise.
Similarly, leaders in Detroit became concerned about the prevalence and burden of diabetes in the greater Detroit area, particularly among underserved Medicaid patients who share the greatest risk of experiencing avoidable exacerbations and complications from diabetes. Like the Cincinnati Beacon, Detroit leaders as a community identified a set of measures that they believe would be indicative of progress in combating the disease. This includes increasing the number of diabetic patients with improvements in blood sugar, blood pressure, and LDL levels; reducing smoking rates; improving the percentage of targeted patients receiving eye and foot exams in a timely and appropriate manner to avoid invasive diabetes complications; ensuring regular interactions with primary care physicians including after hospitalizations or emergency department visits; and increasing appropriate flu vaccine rates, and lowering overall health care costs.
How will Detroit leaders achieve these improvements? They will use their existing IT systems to establish clinical teams to support diabetic patients and those at risk for becoming affected by the disease. These clinical teams will work as extensions of physician offices to securely consolidate patient records regardless of where care is received, encourage ongoing primary care visits to ensure appropriate preventive steps are taken to avert complications; reconcile patients’ medications to avoid duplication and ensure safety; provide educational support to patients about techniques to manage their own health conditions; coordinate patient care after hospitalizations occur to prevent avoidable readmissions; alert primary care physicians and care teams immediately about emergency department visits or hospitalizations; and form learning networks among physicians to share information and data on the best techniques of managing the disease and improving outcomes.
In each case, the technology itself provides the necessary foundation for implementing often simple changes in how physicians and care managers communicate with each other and with patients and their caregivers. To an engineer, this kind of approach might seem commonplace. But in health care, establishing clear community-wide health objectives and measurable improvement targets and designing a multi-faceted set of focused interventions to achieve those goals has been surprisingly rare. One of the gifts of health IT is its ability to support new approaches of this kind and galvanize communities around new, innovative – and often simple – ways to support the kinds of outcomes that matter most to patients and their families.
The Work Ahead
The 15 Beacon awardees announced in May have been busy operationalizing their proposals into clear, logical operations plans. They have been working closely with physicians, hospitals, long-term care and other providers to further develop specific plans to implement these new initiatives. They have been hiring staff and executing contracts with technology and other partners. They have been refining their performance measures and establishing baselines for those measures. And they have assessed potential areas of risk and mitigation plans to avoid them.
These community leaders are now shifting from planning to doing in what will be an ongoing, iterative journey to identify creative combinations of reforms that, together, can help achieve their community performance improvement goals that each community has set.
Finally, while we are still early in the life of the program, Beacon Communities are already thinking about sustainability. While sustainability encompasses a number of important dimensions, a key element is to ensure that the kinds of performance improvements that these communities are aiming for will be more systematically supported in how health care is paid for.
For example, if a community uses health IT tools and resources to reduce avoidable hospital readmissions for chronic patients, the local providers and other partners who have invested in these value-increasing initiatives should increasingly receive more support from public and private health care payers when their efforts lead to better care. Physicians and hospitals are not seeking to implement payment reforms as a means of making more money; rather, they are seeking creative payment models that do not punish them when they take steps using IT to improve health and health care on behalf of the whole community.
Hence, the Beacon Community program will include technical assistance to develop plans for testing accountable care organization (ACO), new bundled or episode-based payments, or advanced medical home payments through which an increasing share of provider compensation is linked to improving care quality and efficiency – i.e., the very performance improvements that Beacon Communities aspire to over the next several years.
Over the course of the Beacon Community program, the implementation lessons learned by these 17 communities will be widely shared to help support the broader use of health IT to support care improvements across the nation. For every community that was ultimately selected to receive a Beacon award, there were more than five strong applicants that did not. This indicates that community leaders at the local level are ready to use health IT in service of specific health goals, and we are working with partners in the private sector to develop broader networks to help all communities pursue these kinds of goals.
Make no mistake – this work is extremely challenging and exacting for those community leaders visionary and capable enough to take it on. It demands new levels of cooperation and new dimensions in the concept of health improvement. It also takes a tolerance for taking risks, testing and refining combinations of reforms that provide both provider and consumer tools and incentives, and measuring results along the way toward iterative improvement. Despite these challenges, we are confident these communities will deliver on their promise for using IT to improve health and health care in their communities.
We will be releasing much more information about the specific activities in each Beacon Community in the future. We invite every community interested in the program or its approach to contact us for information, networking, and action.