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HIMSS18 Reflections on Value-Based Care from a Healthcare Lawyer

Doctor explaining health information to patient with a tablet

Every year, the HIMSS18 Global Conference & Exhibition generates a tremendous amount of opportunity, promise, hype and more. While many pronouncements are usually made at the conference, the question always arises: What will stick following the conference?

From that perspective, a few recurring themes from conversations stuck out in my mind.

Three Crucial Conversations at HIMSS18

The focus of my trips to HIMSS16 and HIMSS17 were privacy and security, but that changed this year. While I still had a number of privacy- and security-focused discussions, I also wanted to learn more about what’s happening on the value-based care front. With that in mind, I met with a number of individuals in the space or others who are considering how to develop tools to assist in value-based care.

Conversation 1: Health Policy

One conversation was with Tom Bizzaro, vice president, health policy and industry relations for First Databank. With Tom, the discussion focused more on the health policy side of the equation. Namely, what is or can be done by Congress and/or regulators within the Centers for Medicare and Medicaid Services (CMS).

Since the beginning of 2017, as the Trump Administration has begun work, the pace of pushing into value-based care through Medicare has taken a more measured approach. Several initiatives are underway, including programs through the CMS Center for Medicare and Medicaid Innovation (CMMI). One example, the Bundled Payments for Care Improvement (BPCI) Advanced Model, may be a glimmer of hope, but any benefit remains to be seen until participants are actually in the program, which will not be for a fair amount of time.

In what would become a recurring theme across a number of conversations, the issue of a unique patient identifier came up. The argument runs that without a unique identifier, many questions arise as to the accuracy and reliability of data about an individual. Even in closed systems, misalignment and others issues arise with data. If that happens in a closed system, how can the larger healthcare ecosystem be trusted to attach the right data to the right person?

From a policy perspective, the issue is not really a desire for the government to have to develop the patient identifier so much as remove the barriers to doing so. A unique patient identifier has long been contemplated under federal law, but policy blocks any attempt to actually begin or otherwise pursue development.

Conversation 2: Patient, Provider, Payer Trifecta

The unique patient identifier concept also factored into my discussion of value-based care with Lidia Fonseca from Quest Quanum. Lidia also identified the need to have reliable data that follows a patient. Diving more into the value-based care realm, Lidia hammered the need to focus on all of the sides that form healthcare – the patient, provider and payer trifecta – and enable each side to access the information that it wants and/or needs.

Examples of such information include transparency around cost for patients, ease of accessing and ordering services for providers by making tools fit seamlessly into workflows, and having claims and service information available and flowing between providers and payers. Combining those elements shifts the focus of the healthcare industry from reacting to events to proactively trying to keep individuals healthy and ostensibly outside the walls of a traditional healthcare provider.

Coming around to design, Lidia’s description of her preferred role as a change agent struck me. Lidia described her role in many organizations as being the person to shake up operations and redesign old systems. She referenced design thinking, which takes empathy as a first step in creating tools. It is hard to argue with the suggestion to bring empathy into the process of recreating the electronic health record or even coming up with completely new tools. Regardless of the approach, the basic message was one of needing to embrace change and push to make it happen.

Conversation 3: Driving Value and Meaning from Data

A third conversation that focused on value-based care was with Mason Beard, co-founder of Philips Wellcentive. Mason described a long-standing role in the realm of trying to drive value and meaning from data as well as shifting the manner in which providers deliver care.

The discussion with Mason also focused on the need for creating new frameworks around relationships and not accepting the status quo. Examples of driving this change could include establishing new terms for arrangements between payers and providers and even potentially shifting solely to more direct relationships between employers and providers.

The rundown above focuses only on prescheduled meetings. The number of informal and/or impromptu discussions about value-based care are too numerous to fully capture. However, the ideas that were the subject of those discussions aligned with the concepts discussed with Tom, Lidia and Mason. The system must continue to change and that recognition is there.

Final Thoughts

As a healthcare lawyer, I want to break down barriers constructed by participants in the healthcare industry through a misunderstanding or misapplication of laws and regulations affecting healthcare. Innovation is possible and even encouraged by those laws and regulations. While the path may not be the first to consider, there is a path, and I want to educate others on the means of finding that path and/or serving as a guide.

The mood during HIMSS18 was one of optimism and energy. It is hard to sustain those feelings throughout and across years. However, all must remember that the goal is to create a better system resulting in better quality and that respects everyone attached to the healthcare system.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.