Archives for February2013

Which populations are appropriate for care/case management focus?

Most commonly, patients are identified through predictive risk analytics as potential high utilizers.  These patients are then the focus for case management.  Question for discussion:

  • We would probably expect to use different case management styles (and even tools) for the very high utilizers (e.g, over $50,000 per year) than for the moderate utilizers (e.g., $10,000 to $50,000 per year).  How many “levels” of case management ought we implement?
  • Would we expect to have significantly different interventions between the levels of case management?

Looking forward to comments.

Costs of IT in support of accountable care

We have recently endured another round of reports noting that investment in healthcare IT does not seem to have very significant ROI.  We have had redundant reports noting that:

  • EMRs may not have significant ROI
  • HIEs may or may not be “sustainable”
  • Industry IT costs are still trending upward, even though healthcare IT investment is generally lower than other information intensive industries

I continue to wonder why buyers are surprised.  ROI is fundamentally based on changes in revenue or cost after an implementation.  If clinical tool sets do not have much effect on either, why would we expect an ROI?

Perhaps more humorously, in a fee-for-service environment (in which most physicians are still practice), ROI is more commonly driven by better billing characteristics (e.g., better coding on bills, more accurate ‘upcoding’) than by process improvement.  In fact, process costs tend to rise in ambulatory care when clinical systems are implemented.

Does anyone think that these reports have any bearing at all on the value of clinical tools when deployed in an accountable care environment?  That is, if we are actually economically incentivized to improve the cost/quality profile, wouldn’t the investment in care coordination tools have much more obvious value?



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