A new, cloud-based platform designed by IBM and ActiveHealth Management aims to take electronic medical records one step further by adding payers to the mix.
This will result not only in better clinical outcomes but better management of the healthcare bill.
The Collaborative Care Solution combines the cloud computing capabilities of Armonk, N.Y.-based IT giant IBM with the CareEngine clinical decision support system designed by ActiveHealth Management, a New York-based subsidiary of Aetna. The new solution is designed to round out the EMR by adding medication and lab data as well as claims information.
“We’re marrying proven practices in medicine with cutting-edge technology,” said Robert Merkel, vice president and healthcare industry leader for IBM Global Business Services. “Our business model is to improve quality and reduce cost. To do that, and in order to grow, we have to keep coming up with new ways of demonstrating value.”
IBM isn’t the only vendor to partner with a payer. Last month, Watertown, Mass.-based athenahealth announced an alliance with Humana that will connect the Louisville, Ky.-based insurer’s Primary Care Rewards Program with athenahealth’s athenaClinicals EHR service. As part of that deal, Humana will subsidize physicians who want to implement athenaClinicals – an offer that will affect roughly 1,000 physicians but could be expanded to reach 20,000 in the Humana network.
In return, Humana will make the data in its Availity CareProfile health information network available to athenahealth.
“Seamless, integrated electronic medical records are a critical necessity in patient care today, greatly reducing the chance of medical errors and duplicative treatment, facilitating a more holistic view of the patient's care profile and improving outcomes,” said Bruce Perkins, senior vice president of Humana’s Healthcare Delivery Systems and Clinical Processes organization.
Merkel said health plans have as much interest in clinical information as physicians, and by leveraging the data gathering and analytics tools that payers possess, physicians are better able to devise a care plan that meets quality and financial goals.
That’s especially true for those with ongoing or chronic conditions like asthma, diabetes and heart disease. Adding insurers and health plans to the mix ensures that care plans are managed and followed, and that bills are properly routed and paid.
Among the first health networks to make use of the new platform is the Sharp Community Medical Group, a San Diego-based network of more than 210 primary care physicians and 600 specialists who provide care for more than 146,000 patients.
“The relationship among Sharp Community Medical Group, IBM and ActiveHealth is really about transforming how we deliver patient care,” said John Jenrette, MD, Sharp’s CEO. “The current state of medicine today is one of paper records, fragmentation and lack of patient information at the right location and at the right time.
Unfortunately, this is medicine’s current state in most organizations and physicians offices. The patient is not engaged in their own healthcare and not connected to their clinical information and doctors in an effective manner. The work we are undertaking will create a system that is patient centric. It will provide the connection among primary care physicians, specialty physicians, hospitals and patients to achieve improved clinical outcomes while reducing costs.”
Officials say the Collaborative Care Solution will help providers achieve NCQA Level 3 Patient-Centered Medical Home status and move toward becoming an Accountable Care Organization – two initiatives included in President Barack Obama’s healthcare reform efforts.
According to a recent Thomson Reuters study, about $800 billion is wasted in the United States each year on ineffective care, ranging from duplicate or unnecessary tests or medical appointments to inappropriate diagnoses based on incorrect information to unnecessary or incorrect prescriptions.
“Our healthcare system needs solutions that can help physicians collect, connect, analyze and act on all the information available to improve a patient’s health. Our solution makes this possible in real-time at the point that care is delivered,” said Greg Steinberg, MD, CEO of ActiveHealth Management.
“The healthcare industry is under tremendous pressure to reduce costs while improving quality of care,” added Merkel. “Collaborative Care assists in achieving these goals by providing advanced clinical services that complement EMRs and removing the infrastructure costs by delivering these services through cloud computing.”