(SPONSORED) John Glaser, Ph.D., CEO of the Health Services Business Unit of Siemens Healthcare, sees health IT as the enabler for the transformation of the healthcare delivery system. He discusses how new paradigms on reimbursement, transparency and patient centricity are driving healthcare providers to deploy innovative technologies for the ultimate goal of delivering high-quality, cost-efficient clinical care and outcomes.

Glaser is responsible for heading Siemens’ global healthcare IT business. Previously, he was Vice-President and CIO of Partners HealthCare, Inc. He was the founding chairman of the College of Healthcare Information Management Executives (CHIME), and is the former chairman of the eHealth Initiative Board and the Board of the National Alliance for Health Information Technology. He is a former Senior Advisor to the Office of the National Coordinator for Health Information Technology (ONC).

Q: As the industry moves toward a vastly more complex reimbursement environment, what do you consider to be the most significant ramification of the transition from a volume-based business model to a value and outcomes-based model?

A: The payment model transition means, at its core, that the performance of the provider organization must take big steps forward. With payment so tightly linked to quality and outcomes, the need to track, improve and measure key aspects of organizational performance – productivity, care quality and safety and operational efficiency – becomes paramount in an accountable care environment.

It is not possible to effectively respond to the transformation of healthcare without a solid base of IT. It’s all about monitoring, predicting and improving performance. If an organization doesn’t know whether it’s making or losing money on a particular risk arrangement such as a bundle or episode or if the quality of its care is deteriorating, that organization could wind up in a great deal of financial trouble in fairly short order.

Today’s providers will need to leverage their core IT systems to help ensure that care processes and operations conform to best practices and the evidence. For example, electronic health records should be implemented in ways that make it easy for providers to do the right thing and make the best decision. In addition, the IT systems must enable the organization to measure the effectiveness of care protocols, such as medication compliance for a population of diabetic patients. Surgical services will need to understand the costs and quality of their procedure bundles. Primary care practices will need to ensure that patients are receiving necessary preventive care. Understanding what works and what does not is key to ensuring appropriate reimbursements, controlling costs, and most importantly, providing the best care for the patient.

Q: As a result of the industry undergoing such dramatic change, there’s a great deal of focus and pressure on provider performance across the entire continuum of care. How has this impacted Siemens’ development strategy in terms of ensuring you are well equipped to meet the needs of your customers beyond the acute-care environment?

A: Certainly, health reform initiatives are driving a very different paradigm than traditional fee-for-service reimbursement. Managing chronic illness, reducing hospital admissions as well as promoting adherence to health maintenance requires care that is orchestrated across the continuum. The primary care provider and interdisciplinary care team, in partnership with the patient, are at the core of this strategy. Patients’ care must be tracked, managed, coordinated and connected across the continuum to achieve desired quality outcomes at reduced costs.

As such, success in this new environment calls for tightly integrated ambulatory, acute-care, and post-acute care clinical, revenue cycle and business intelligence solutions to effectively coordinate care, improve overall operational efficiency and respond to the new reimbursement mechanisms. So that’s precisely how we’ve been focusing our development efforts.

Most notably, we are leveraging the capabilities of Soarian® Clinicals to deliver an integrated clinical solution to the ambulatory physician office and clinic environments. Our approach takes advantage of Soarian’s existing capabilities, such as embedded workflow, clinical content and business intelligence, while developing net new functionality to optimize clinician workflow and usability in ambulatory care venues. Similarly our revenue cycle solutions have been extended across the continuum. The ultimate goal is to deliver a robust enterprise solution that facilitates and supports coordinated patient care in a meaningful way.

Q: Changing care and reimbursement models are also driving providers to take more proactive approaches to managing and improving the health and well-being of their patient populations. Are you seeing a desire for IT tools that provide this capability in the market?

A: Indeed, we are, and this area of need is only expected to grow and become more sophisticated. Increasingly, you have healthcare organizations that have taken on insurance risk contracts with payers, employers or government agencies. Examples include an IDN assuming risk for surgical procedure bundles, a hospital entering into a risk contract with a local payer where payment is based on achieving quality targets, and ACOs participating in Medicare Shared Savings.

In order to do population health and care management effectively, providers might need to “knit together” multiple EHRs, financial systems and analytic solutions. As multiple healthcare organizations coalesce to manage performance and utilization risk in their communities, they will require high degrees of interoperability among these systems.

In fact, we’re excited to debut our new CareXcell™ offering right here at HIMSS. CareXcell will help healthcare organizations enter into risk arrangements in which they proactively manage the health of the population across traditional acute and ambulatory encounters. It does this by aggregating patient and care data in order to organize the population into meaningful groups according to their health needs. CareXcell triggers actionable interventions for use by the expanded care team based on evidence-based care plans and patients’ health status and goals. And it connects and informs every provider in the care community – regardless of EHR. So again, another key focus of our development efforts support the additional challenges our customers are facing in this era of reform.

Q: No Q&A would be complete without asking you to share some perspective on the status of the EHR Incentive program. How do you feel the industry is fairing?

A: There is no question that the needle has moved in a very positive direction as a result of the Meaningful Use program. The focus on use that is meaningful shifted the industry from its prior focus on adoption. The number of hospitals that adopt computerized provider order entry is less important than whether those hospitals use CPOE extensively to enter orders.

However, using EHRs to improve care requires more than a shift in focus. It requires implementation assistance to providers, increased numbers of clinical systems professionals and advancement of standards for interoperability. It also requires quality measures, clear privacy and security requirements, and the furthering of the health information exchange infrastructure.

Programs, initiatives, funding and advisory committees have been put in place to ensure that these supporting mechanisms are established. So, overall, there are many thoughtful, well-conceived and well-executed aspects of the program.

But, moving forward – particularly with Stage 2 attestations and in looking at Stage 3 requirements – we should be mindful of the need to calibrate the pace and direction of change. Moreover, we should take time to ensure that, as the program progresses, we are seeing evidence that the desired goal of improved outcomes is being achieved. Hence, we should assess the gains in care quality, safety and efficiency by providers that have successfully attested. And we should assess provider ability to perform associated process re-engineering and care improvement steps needed to optimize the significant investments being made in EHRs.

That said, the Meaningful Use program will continue to be a critical contributor to our country’s efforts to improve care delivery, and I think we can all be very proud of what we’ve accomplished to date.

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About Siemens: Siemens provides healthcare IT solutions and services that enable care delivery organizations to thrive as they address access, costs, quality, and safety of patient healthcare.