By Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University
In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable ‘killer apps’ for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.
Chronic Care Continuum App
Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.
“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need”.
Typical steps for substance abusers when entering a behavioral health center include a physical and mental exam, meeting with an intake coordinator, a nurse, and a counselor. Those addicted also often suffer from depression, requiring a psychiatrist and a meeting with the detox center at the hospital. Other potential social problems such as court battles for child support, financial issues such as bankruptcy or possible jail time and can’t carry their files to each clinic and bring the appropriate information to the correct provider. Patients in these situations are often unable to receive the care they need to address physical or mental health issues let alone integration of services.
CMS promotes this type of integration through its Chronic Care Management Service which encourages primary care providers to monitor, anticipate and collaborate with other care providers. In addition, long term chronic care treatment enables clinics and hospitals to build up a roster of new and potentially long care patients to build revenue.
Integration of Mental and Physical Care Apps
Meanwhile, the final “killer app” mentioned by Schmidt is the integration of mental health and physical care which has traditionally been a challenge in healthcare. Mental Health America (MHA) believes that treating the whole person through the integration of behavioral health and general medical healthcare can save lives, reduce negative health outcomes and facilitate quality care while promoting efficiency and cost savings.
A good example of the importance of the linking of mental, behavioral and physical health is when a patient completes a full behavioral health treatment, they still must often contend with medical issues such as hypertension, diabetes, depression and possibly more. Patients can easily fall back into drug addiction and alcoholism if surrounding symptoms are not treated, placing even greater importance on collaboration.
“The healthcare industry is now looking at revenue which can be generated through the interoperability of AWVs, chronic care and service care transitions between physical and behavioral health services,” says Doug Brown, managing partner, Black Book Research. “Hospitals and healthcare clinics that can connect these services with technologies such as the Zoeticx ProVizion cloud based, bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.”
“Integrating EHR data and using bi-directional patient information flow technology to enhance patient care is the goal of healthcare institutions. If you can do that while driving revenue through population programs like AWVs and behavioral health services, you are moving healthcare forward,” says Richard A. Royer, CEO, Primaris, a healthcare consulting firm that works with hospitals, physicians, and nursing homes to drive better health outcomes, improved patient experience and reduced costs.
Where Are the Killer Apps?
However, there are already “killer apps” for this type of care integration which are designed to address gaps and meet the needs of those impacted by behavioral and physical health. Some solutions include Zoeticx ProVizion, a system of apps for streamlining collaborative preventive and behavioral care while OCHIN and LifeWorks Northwest have partnered to enhance data sharing across a community of provider networks. Alluceo offers a team-based approach to mental health services that is integrated and leverages a digital platform to facilitate communication.
At Rehobath McKinley Christian Healthcare Services (RMCHS), hospital CEO David Conejo has been able to increase revenue while improving behavioral healthcare for a large reservation of Navajo Indian’s outside of Gallup, New Mexico where many suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits.
In addition, the app includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day, that’s an extra 180 minutes. More minutes, more patients.