Opportunities in Connected Health, Part 3: Provider perceptions & expecations

After writing the first two in this series “Opportunities in Connected Health”, I’ve struggled.  I knew the theme, some variation of “follow the money” to consider whether providers really believe now is the time to adopt connected health technologies.  After several aborted drafts, I found an approach.

For the past 7 years, I’ve served as mentor for a class of graduate students in health informatics at Indiana University Purdue University at Indianapolis under Dr. Josette Jones.  I have had the honor of working with over 20 teams of remarkable students as we consider the role of patient engagement and care collaboration as it relates to difficult subjects including addiction, traumatic brain injury, palliative health, pain managment and others.  

This semester we took a different approach, investigating basic perceptions and expectations for behavioral health providers, accountable care organizations (ACOs) and others in response to recent changes in payment models and compliance / certification requirements.  A key part of this was a online survey.  Following is the summary report associated with that survey. 

Survey of Expectations for Technology-enabled Patient Engagement and Community Care Collaboration

By: Harshpreet Chandok, Joseph LaRosa, Sunanda Mukherjee

Gopinanth Sivasankran, Aveen Sufi, and Mengye Yang

 Instructor:  Dr. Josette Jones, Director, Health Informatics 

Mentor: Doug Dormer, CEO, White Pine Systems

December 15, 2015

 Study Summary

Perceptions Summary
Over 90% of  health care organizations responding to an Indiana University/ White Pine Systems online survey agreed or strongly agreed that recent and emerging changes in payment models and compliance requirements will make it important to use technology in new ways to improve community care collaboration and patient engagement. However,
only 42% expressed confidence that their present EHR and HIE platforms will be able to fully meet these new requirements. 78% of respondents indicated that acquiring such technology is in their strategic plan for the next year. 73% of all respondents agreed or strongly agreed that these new technologies would contribute to their financial sustainability.  This suggests that these recent and emerging changes are likely to lead to increased use of technology for patient engagement and community care coordination in the near term. However, there are differences in perceptions and expectations between behavioral health providers, accountable care organizations and other health organizations.

Background

Studies show that recent changes in payment models and regulatory requirements [i](particularly as a result of the Affordable Care Act) have caused a significant increase in the use of electronic health records and health information exchange among healthcare providers. However, the use of technology to extend evidence-based practice beyond the clinic to the patient and community is still in its very early stages. Studies have also shown that consumers desire greater access to health services (not just health information) through technology.

Four current and emerging changes in payment models and regulatory requirements may have a big impact on both healthcare delivery and health information technology:

  • The increasing role of Managed Care Organizations (MCOs) for Medicaid beneficiaries;
  • The increasing role of Accountable Care Organizations (ACOs) for both Medicare and private payers;
  • The proposed Merit-based Incentive Payment System (MIPS), which includes Meaningful Use Stage 3 requirements and value-based payment adjustments that are scheduled to go into effect in 2019, and;
  • The Excellence in Mental Health Act, specifically the proposed Certification for Community Behavioral Health Centers (CCBHC’s).

This survey is designed to identify basic perceptions and expectations for behavioral health providers, accountable care organizations (ACOs) and others in response to these recent changes in payment models and compliance / certification requirements.

This project was conducted by a six-member team of graduate students under the direction of Dr. Josette Jones, Director, Health Informatics, Department of Bio Health Informatics, Indiana University School of Informatics and Computing – Indianapolis. Doug Dormer, CEO of White Pine Systems, served as mentor for the project.

For purposes of this survey, we use the following definitions:

Patient engagement refers to the use of online and mobile portals and applications to extend evidence-based practice beyond the walls of the clinic to provide increased access to services without increasing labor while gathering new information about patient health behaviors and outcomes.

Community Care Collaboration refers to the use of online and mobile portals and applications to extend evidence-based best practices to social services such as employment, criminal justice re-entry and other social supports.

Methodology

The online survey was conducted between November30 and December 12. The survey was distributed by email and word of mouth as well as through social media including Twitter, Facebook and LinkedIn. The Health Information Management Services Society (HIMSS) tweeted the link to the survey and the National Council of Behavioral Health included it in its membership newsletter. The survey received 107 responses.

Survey Findings

The survey was organized around four “perception” domains for the use of technology to improve Patient Engagement and Community Care Collaboration: Importance, Confidence, Timeliness, and Value.

  • Although over 90% of all respondents agreed or strongly agreed that using technology in new ways was important, only 42% expressed confidence that their current EHR and HIE systems could fully meet these emerging requirements;
  • 40% of ACO respondents were confident that their current EHR systems would be able to meet these requirements, while only 25% of behavioral health (BH) organizations were confident their current EHR system would be able to meet these new requirements;
  • 76% of all respondents indicated that acquiring technology to improve patient engagement and community care collaboration was in their strategic plan for the upcoming year.
  • When asked about the effect on the organization’s financial sustainability, 73% of ACOs agreed or strongly agreed that new technologies for patient engagement and community care collaboration would improve financial sustainability compared to only 50% for behavioral health providers.
  • Respondents generally fell into three organization types: 48% reported as Accountable Care Organizations, 12% as behavioral health providers, and 40% identified themselves as “other” including insurers, health information exchanges, and healthcare membership organizations.Key drivers
  • When considering which payment and regulatory initiatives were most drivers of change, ACO respondents scored Medicare/Medicaid ACOs as the most important, whereas BH respondents scored Medicaid MCOs as the most important.
  • ACO and BH respondents diverged when measuring the importance of payer-focused ACO requirements with 92% of ACO respondents indicating that payer-focused ACO requirements were most important compared to 67% for BH respondents.
  • Both ACO and BH respondents ranked Certified Community Behavioral Health Clinics as the least important consideration for change at about 67% scoring very important for BH respondents and 61% for ACO respondents.
  • Function & feature rankingThe ranking of desired functions and features was similar but not identical between BH and ACO respondents. Text-based questions and answer technology ranked highest for behavioral health, while text–based reminders and confirmation was ranked highest for ACOs.
  • Overall, emerging technologies like health games and passive monitoring tools ranked lowest.

 Discussion

The number of responses to the survey was quite low, with only 107 total responses.  This may suggest that the percentage of provider organizations for whom patient engagement and community care collaboration is important is also low.  Or it may simply be the survey, relying on social media to distribute, did not reach enough potential respondents, or that providers receive many invitations to participate in surveys and are selective in those they answer.

The survey results appear to be consistent with the major drivers of change in healthcare generally, with an increasing shift from prescriptive requirements for use of health information technology to more outcomes-based measures that rely upon technology as a component of service delivery rather than directly measuring technology functionality and use.

The biggest overall driver of change appears to be the ACO financial models for Medicare.  BH respondents and ACO respondents differed over the importance of payer-based payment models.  This may be because BH services are not as well integrated into private payer plans and incentive programs as they are in Medicare or Medicaid.  There are other possible explanations which could be also be explored.

While the Merit-based Incentive Payment System, which will affect all Medicare and Medicaid service providers beginning in 2019, ranked as an important change driver for all respondents, the Certified Community Behavioral Health Clinic requirements ranked lowest for both ACOs and BH respondents at about 42%.  This could be a result of the early stage of development of standards for CCBHC compared to the other initiatives.

With respect to specific features and functions for patient engagement and community care collaboration, the answers of all respondents showed similar priorities. The highest ranked priorities were: text-based communication, improved workflow and social engagement. Interestingly, new technologies such as health games and applications or passive monitoring tools like GPS or activity sensors, which have recently received much attention in the industry and in the press, were ranked the lowest by all respondents.

Conclusion:

While the validity of public online surveys may be limited due to self-selection bias and the nature of unavoidably leading questions, the data does present some strongly suggestive insights.

The data is reflective of the current national status regarding the overall progression in the use of health information technology.  In the authors’ views, HIT still lags the use of technology in other areas of our lives.  Nonetheless, this survey suggests that technology for patient engagement and community care collaboration may be poised for significant growth, although it may still be at an early adopter stage.  Whatever other conclusions, the next three years are likely to see significant changes in the way all providers use technology to engage patients and communities.

For more information or to see the full report, please contact Doug Dormer:  ddormer@spinnphr.com.

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