During a recent exchange with sixteen national firms that offered a multi-stakeholder perspective, an interesting question surfaced: what is the “healthcare financial network”? Besides being characterized as critical infrastructure by Homeland Security, deemed the target of government reform in the Affordable Care Act and impacted by 5010 compliancy and ICD-10 transformation, well, what is it?
Upon hearing the term, some automatically think of benefit design that can change consumer behavior, or aligning payment incentives among the stakeholders to fill gaps of care in the community and reduce excess consumption. Others think of the financial infrastructure that supports care models, whether ACO, medical home, or others, by moving information and dollars to point of need in the system at any given moment.
After a good exchange we re-framed our discussion. It’s hard to discuss one and leave out the other, yet we were able to focus on one area: financial infrastructure.
Three essential components surfaced: integrated information (including clinical and financial), consumer engagement and innovation. Privacy and security, standards (not more technology), and applied analytics were listed as well, though none as prominently as the first three. Interestingly, guiding principles were developed that excluded consumer-centricity in favor of complete objectivity around care models.
Mapping our dialogue to government-driven changes, are we advancing policies that further financial infrastructure around the three top priorities identified by our focus group?
Well, the Affordable Care Act facilitates electronic business processes. That tracks well with integrated information, sets the stage for investment in digital innovation as processes migrate away from paper and could mean real time access to information—something consumers often demand.
What about the other areas, such as meaningful use of health IT, 5010 or ICD-10 transformation? And what about curbing fraud and abuse in this new digital business environment via automated recovery audit contractors (RACs), or Medical Loss Ratios among payers, or how about wireless tools that advance the medical home?
These are the kinds of questions that the new HIMSS G7 Roundtable will focus on. Clearly, organizations need a vision beyond the broad sweep of transformation to prepare for changes in banking and financial systems infrastructure that support care models. Learn how you can participate at www.mbproject.org.