Now You Have Health Care Data. So Where Does It Go?

Paul Grundy

Posted 1/15/12 on IBM Healthcare Perspectives

In the next 10 years, data and the ability to analyze it will do for the doctor’s mind what x-ray and medical imaging have done for their vision.  How? By turning data into actionable information.

For instance, take Watson, IBM’s intelligent supercomputer application. Watson can analyze the meaning and context of human language, and quickly process vast amounts of information. With this information, it can suggest options targeted to a patient’s circumstances. This is an example of technology that can help physicians and nurses identify the most effective courses of treatment for their patients. And fast: in less than 3 seconds Watson can sift through the equivalent of about 200 million pages, evaluate the information, and provide precise responses. With medical information doubling every 5 years, advanced health analytic systems technologies can help improve patient care through the delivery of up- to-date, evidence-based health care.

Great, Now We Have Data

But if docs are still paid for a minute of time and an episode of care and not held accountable for the care they deliver, using the data will be of little value. So, how to make sure this actionable information flows and is held accountable at the level of a healing relationship?

With this question in mind, in 2006 IBM – as a buyer of care – hosted a meeting for 47 of the Fortune 100 buyers, TRICARE, the Federal Office of Personnel Management (OPM), buyers and the whole house of primary care. They agreed to guidelines now known as the Joint Principles of the Patient Centered Medical Home (PCMH).

A New Approach

PCMH  is defined as “a health care setting that facilitates partnerships between individual patients and their personal providers and, when appropriate, the patient’s family.” It lies at the center of the effort to get at population health, integrated and coordinated team-based care. It is where the primary care healer leads an organization with comprehensive, accessible, holistic, coordinated, evidence-based care coordination. The data that flows into the PCMH drives clinical integration and facilitates accountability.

The Vote Is In

In the USA, the PCMH is now the standard for the US Veterans Administration and the US military.  Also, under the health care reform law Accountable Care Organizations (ACOs) will be created in 2012. This will likely increase PCMH’s importance, since they are foundational to making ACOs work.  ACOs are a combination of primary care, specialists and hospitals tied to a defined population, accountable for the quality, outcomes and cost of health care received by that population.  PCMH’s healer relationship is the care foundation that is accountable.

PCMH is the accountable care foundation for the Agency for Healthcare Research and Quality’s (AHRQ) PCMH Resource Center, for the Department of Defense (DOD), for the Veterans Administration (VA), for the Health Resources and Services Administration (HRSA), and for the Federal Employee Health Benefits (FEHBP) program.

One recent example can be found in Montana.  On December 1st, 2011, Montana followed many others to become the 38th state to use PCMH as a foundation for state-based, commercial and publicly funded care. To top it off, health plans that cover most of the states now are also making “PCMH the foundation they build on and pay against.” Another example: PCMH was so successful in Ontario that it is now going nationwide in Canada.

The First Evidence Is In

When applied to the PCMH team approach to health care delivery, data analytics have been proven to significantly reduce emergency room visits and hospital re-admissions. There is a good deal of evidence that this approach results in  lower hospitalization rates, better value, lower overall healthcare cost as well as improved patient health.  Let’s start paying for a system where we pay less for comprehensive, integrated care, in which primary care, formatted as a PCMH, takes on more responsibility for coordinating care and improving patient’s health.

More resources and data on PCMH level care:

Paul Grundy MD, MPH, FACOEM, FACPM is IBM Corporation’s Global Director, IBM Healthcare Transformation and the President of the Patient Centered Primary Care Collaborative.

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