{"id":207,"date":"2013-03-04T09:27:11","date_gmt":"2013-03-04T17:27:11","guid":{"rendered":"http:\/\/intercase.org\/?page_id=207"},"modified":"2014-12-29T10:32:56","modified_gmt":"2014-12-29T18:32:56","slug":"virtualize-access","status":"publish","type":"page","link":"http:\/\/intercase.org\/?page_id=207","title":{"rendered":"Virtualize Access"},"content":{"rendered":"<p style=\"text-align: center;\"><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-333 aligncenter\" src=\"http:\/\/intercase.org\/wp-content\/uploads\/2013\/03\/Accountable-Care-Process-flow-Virtualize-v011.png\" alt=\"Accountable Care Process flow Virtualize v01\" width=\"770\" height=\"131\" srcset=\"http:\/\/intercase.org\/wp-content\/uploads\/2013\/03\/Accountable-Care-Process-flow-Virtualize-v011.png 1425w, http:\/\/intercase.org\/wp-content\/uploads\/2013\/03\/Accountable-Care-Process-flow-Virtualize-v011-300x51.png 300w, http:\/\/intercase.org\/wp-content\/uploads\/2013\/03\/Accountable-Care-Process-flow-Virtualize-v011-1024x175.png 1024w\" sizes=\"(max-width: 770px) 100vw, 770px\" \/><\/p>\n<p><strong>What is &#8220;Virtualized Access&#8221;?<\/strong><\/p>\n<p>We use &#8220;virtualized access&#8221; to mean exactly one thing:<\/p>\n<ul>\n<li>All participants in the plan of care can see (and act on) the same plan of care<\/li>\n<\/ul>\n<p>By &#8220;participants&#8221; we mean all providers, the patient and the patient&#8217;s family.\u00a0 This is a slightly different statement than suggesting that all participants should be able to see the &#8220;chart&#8221; for the patient.\u00a0 For most patients, fragments of their chart exist in many places (that is, at each provider a patient visits).\u00a0 A &#8220;virtual chart&#8221; would integrate all of these chart fragments into a single uniform view of the entire chart.\u00a0 Virtual access to a chart is feasible, but rare.\u00a0 Unfortunately, virtual access to a common plan of care is even rarer.\u00a0 Some large integrated delivery systems have implemented multi-clinical-setting electronic medical record (EMR) systems that create an integrated view of the chart.<\/p>\n<p>In those environments where <span style=\"text-decoration: underline;\">all<\/span> providers and patients are attached to a single medical group or provider system <span style=\"text-decoration: underline;\">and<\/span> that provider system has a broadly-installed EMR system <span style=\"text-decoration: underline;\">and<\/span> the patient portal gives patients access to the electronic chart, existing clinical systems <span style=\"text-decoration: underline;\">might<\/span> be able to support virtualized access to a plan of care.<\/p>\n<p>But the EMR per se is only foundational to the next step:\u00a0 giving all participants (including the patient\/family) access to the plan of care.\u00a0 The plan of care has to exist, and everyone who participates in it has to be able to see it.\u00a0 Most clinicians and patients do not have have access to such technology.\u00a0 And some categories of patients (particularly Medicaid and Medicare\/Medicaid dual eligible patients) almost never have all of their providers in a single organization.<\/p>\n<p>In most instances, patients move between separate provider organizations (technically, separate &#8220;PHI domains&#8221;) and this makes the technical solution a little more complicated.<\/p>\n<p><strong>Don&#8217;t HIEs solve this problem?<\/strong><\/p>\n<p>HIEs\u00a0 (Health Information Exchanges) were intended to solve a portion of this problem.\u00a0 However, most HIEs are (to be gentle) a little bit rudimentary in solving the clinical coordination problem.\u00a0 Some HIEs indeed enable access to some clinical data.\u00a0 To our knowledge, none of the classic HIEs enabled access to a common plan of care.\u00a0 The existing industry standards are a little behind supporting this function.<\/p>\n<p>(FYI, we use the sort-of-standardized definition of &#8220;HIE&#8221; here:\u00a0 a tool set that provides access to &#8220;federated&#8221; data via centralized indexes and &#8220;edge&#8221; services for each data location.\u00a0 This definition excludes tools that centralize data.\u00a0 We also do not believe that large HIE clinical federated databases will ever be economically successful, but that is another story.\u00a0 The next-generation &#8220;HIE&#8221;s with centralized repositories are not truly HIEs in the classic sense.\u00a0 These are clinical data aggregators, and are far more useful and cost effective.\u00a0 The short story here is that classic HIEs are not particularly useful, but the newer clinical data aggregation tool sets are much more so.)<\/p>\n<p>To be sure, the need for virtualized access to a common plan of care is not a rare problem.\u00a0 It is fairer to say it is a generalized problem in the industry.\u00a0 It has generally not been trumpeted as a significant issue because most providers are not accountable for care, and no one really wanted to bear the cost of the technology unless it was economically justified.\u00a0 But technology is not really the core problem.<\/p>\n<p><strong>Technology is not the problem?<\/strong><\/p>\n<p>As much as we enjoy chattering about technology and cool products, technology is indeed not the problem.\u00a0 It is technically feasible to implement and operate a\u00a0 secure, virtualized plan of care for about $5-15 per member per year.\u00a0 But if an organization is not going to deploy the care management processes to manage the costs of care down (which cost far more than the technology), the investment is not worth the expense.\u00a0 However, if the provider organization does indeed expect to implement the care management processes (e.g., stratification, care plan development, patient engagement), the technology costs are incidental.<\/p>\n<p><strong>More simple arithmetic<\/strong><\/p>\n<p>How can I contend that $5 to $15 per member per year is incidental?\u00a0 Consider the following example:<\/p>\n<ul>\n<li>Patient population: 100,000 members<\/li>\n<li>Average cost per patient (annual):\u00a0 $10,000 (this is probably reasonably close for 2014)<\/li>\n<li>Total population cost (annual):\u00a0 $1,000,000,000<\/li>\n<li>Care management cost reduction target (annual):\u00a0 5-7% ($50 to $70 million)<\/li>\n<li>Care management process costs (annual):\u00a0 Approximately $10-15 million<\/li>\n<li>Portion of care management costs attributed to technology (assume $10 annual\u00a0 per patient):\u00a0 $1,000,000<\/li>\n<\/ul>\n<p>Does it make a lot of sense to focus on getting the technology costs down?\u00a0 Wouldn&#8217;t it make more sense to focus on the cost reduction target or attempt to optimize the care management process costs?<\/p>\n<p>If the clever, seductive logic above tickles your interest, you probably ought to call us.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is &#8220;Virtualized Access&#8221;? We use &#8220;virtualized access&#8221; to mean exactly one thing: All participants in the plan of care can see (and act on) the same plan of care &hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":126,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/pages\/207"}],"collection":[{"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=207"}],"version-history":[{"count":34,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/pages\/207\/revisions"}],"predecessor-version":[{"id":405,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/pages\/207\/revisions\/405"}],"up":[{"embeddable":true,"href":"http:\/\/intercase.org\/index.php?rest_route=\/wp\/v2\/pages\/126"}],"wp:attachment":[{"href":"http:\/\/intercase.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=207"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}