Plugging Into The Future Of Health Care
October 14th, 2010
 by
Lonny Reisman
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Lonny Reisman, Aetna’s chief medical officer, was a participant in an August 5 National Press Club briefing on steps the private sector can take to promote meaningful use of health IT. The briefing was cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights some aspects of Reisman’s presentation and supplements his discussion.
Too often, the health care policy discussion in America is academic, political, theoretical — and unplugged from everyday realities. The discussion lacks the real-world experiences that each of us, our family and friends face in dealing with a complex and disconnected health care system.
For example, discussion around health information technology (HIT) often trends toward platforms and portals. This is necessary. But let’s also discuss the everyday reality that doctors’ offices across much of the country don’t have adequate technology and clinical decision-making resources to better assist patients.
And let’s discuss how this reality impacts very real patients. Meet Mrs. Smith. She is a composite of friends and family members who we all know and care about. She is a 65-year-old grandmother who suffers with diabetes, congestive heart failure, and kidney disease. She recently underwent a lumpectomy for early stage breast cancer. Right now, she is doing great.
She’s doing great, in part, because she belongs to a health care system that employs HIT that integrates information from all her physicians. This allows her doctors and family to collaborate so that her care for all these ailments is safe and scientifically sound. The system also helps her meet real-life challenges like transportation to her doctors’ appointments, or simply helps her and her caregivers understand what care she gets and why. Let’s take a look.
Sometimes there is something missing or wrong in her complex care. For example, after her lumpectomy, she missed the fact that she needed radiation therapy to complete her treatment. Fortunately, her health system’s HIT identified the oversight and her doctors were informed. She got the radiation treatment. And recently, the drug that she had been taking for years for her diabetes had to be stopped. Over time her kidneys had deteriorated. Although the drug was doing a great job with her blood sugar, according to the manufacturer, it is unsafe in patients with kidney disease. Her doctors were quite pleased that the system’s HIT had picked up the problem, since the doctor who ordered the drug didn’t know that another doctor had ordered the kidney test that was now abnormal.
HIT systems today can find potential errors in care, help coordinate the health care system for members overwhelmed by serious medical conditions, and help them get the care that they need. In this patient’s case, the system alerted the patient and her physicians about the need for treatment for her breast cancer, and the newly apparent dangers associated with her diabetes drugs. A nurse from her health plan connected directly with the patient to ensure she understood the information that had been provided and helped her avoid an unnecessary and perhaps life-threatening health event — as well as avoid the associated costs.
So how does one find and enroll in this system? One option would be the exceptional, but rare, integrated delivery networks scattered throughout the country where specialists are co-located and physically able to connect. But that’s not the only option. Another is a system that can achieve the same kind of integrated, connected outcome virtually through HIT. The promise of HIT is very real and can change a disconnected system to one that meets our expectations of improved health outcomes.
Missing the opportunity
Unfortunately, many millions of Americans do not enjoy access to the same life-saving health care technology — technology that health insurers can provide and that can positively impact quality and lower costs. HIT has the power to digitize patient records into electronic health records (EHRs) so they’re accessible, shareable and interactive. Patient data from disparate sources (physician EHRs, labs, pharmacy, claims, and more) can be connected. Evidence-based applications and clinical decision-support tools find potential gaps in care and help eliminate redundancy and waste. This level of integrated data also improves the workflow among care team members, helps members understand and adhere to treatment plans, and removes barriers that may prevent members from most effectively navigating the health care system.
In 2009, a record $2.5 trillion was spent on health care in the United States. And yet, Americans get the care they need only about half the time, according to a RAND study. These integrated HIT capabilities are critical to addressing the challenges we face as a nation in providing affordable, high quality health care. In fact, the future of health care in America depends on it.
Connecting with the right solutions
The President and his administration are rightly pushing to move us faster down this road, through funding and regulation, to make HIT something that will benefit all Americans. There will be no turning back from this revolution in health care. But the expectations we have for this solution will only be met if the standard for success is not connectivity, but rather how the technology advances patient outcomes.
Aetna, in partnership with the Office of the National Coordinator for Health Information Technology, is actively engaged with other key players to find solutions. We encourage the advancement of electronic sharing of information among physicians, medical practices, hospitals, pharmacies, labs and consumers to improve quality and reduce costs. Our combined support will enable physicians to collect, analyze and act on all the information available to improve a patient’s health.
Signs of success
Studies from Aetna’s subsidiary and HIT powerhouse, ActiveHealth Management, illustrate that improvements in clinical care and reductions in cost can occur when electronic quality data is used as a regular part of medical practice.
The ActiveHealth CareEngine® continuously scans clinical data on patients, compares it to evidence-based guidelines, and sends “care alerts,” to physicians and patients when it detects an opportunity to improve care or prevent a serious medical complication.
One study showed that the provision of advanced clinical decision support through CareEngine® technology was proven to reduce hospitalizations by 8.4 percent and save more than $8 per member per month (PMPM).
A follow-up study showed there was a $22 reduction in PMPM charges for the group receiving advanced clinical decision support as compared to the control group.
Investing in the future: Collaborative Care Solution
We recently announced that Aetna has entered into a significant relationship with IBM to jointly design, develop, market and operate, through ActiveHealth Management, a unique product called Collaborative Care Solution, a suite of health information and clinical decision support software. It is the solution that creates Mrs. Smith’s integrated health care system. It harnesses patients’ health data from multiple sources and brings together clinical decision support and deep analytics through a health information exchange. Doctors can then act on information in real time and communicate with their patients (in person or electronically through secure channels) to make better decisions and keep patients healthier.
This solution works with EHR systems and offers complementary capabilities and value-added services that extend the value of data collected from them. These include predictive modeling, risk stratification, population management, and a patient portal for secure messaging and education to engage patients in their care. The Collaborative Care Solution combined with an EHR will also fully meet all meaningful use criteria and quality for government incentives.
It is vital that there is broad based support for the adoption of HIT in clinician offices. Such systems can help patients like Mrs. Smith get all the services they need in a coordinated way.
A new role in supporting physicians and members
With the advent of health care reform and the eventual availability of health insurance for most Americans, insurers expect to play a foundational role in applying our capabilities to the seemingly intractable, and now expanding, challenges around controlling medical costs and maintaining high quality care.
As insurers make new professional and technological capabilities available, such as the Collaborative Care Solution, to support patients and their doctors, we have gone beyond our traditional roles. We are now in a position to participate directly in the facilitation of higher-quality and more-efficient care. For example, another step Aetna will take include offering financial incentives, through its provider contracting process, to physicians who achieve specific administrative and quality goals through implementation of EHRs.
We’ve got to do it now
Collaboration is the key to maximizing investments in health information technology. The public and private sectors need to work together and with focus to build the electronic health care platform of the future. With broad-based, systemic change made possible by a technological transformation of the health care system we can eliminate wasteful, even harmful, practices that are at odds with medical best practices. Only then can we be sure our family members, like Mrs. Smith, are getting the care they need.
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