It has been several years since the federal government
enacted the Patient Protection and Affordable Care Act (“PPACA”). Since that
initial movement to swell the number of healthy individuals covered by some
degree of insurance, focus is shifting to
efficiency. New uses of
technology are a major aid, arguably the biggest, in the drive to efficient
care for millions of Americans. To
aggregate so many alternative payment methods and then discern a plausible way
forward, analytics must defy the old adage “less is more” and utilize a more
recent phrase: “Big Data.”
For decades, the traditional, fee-for-service
pay model rewarded the sheer bulk of procedures that a provider
performed. Under that model, an improper
diagnosis that required more visits and time from both doctor and patient would
reward a doctor with more pay, whereas a doctor with the correct diagnosis and prescription
in a single interaction was paid less even though their analysis was higher
quality.
As part of an effort to curb rampant waste in the
fee-for-service model (“FFS”) and encourage the best possible health care
experiences for everyone involved, the Department of Health and Human Services
(“HHS”) set specific
goals and launched the Health Care Payment Learning and Action
Network (“Network”). The goals are to
tie together 30% of Medicare FFS payments with quality or value through
alternative payment models. The Network is the online tool that will advance
and spread the progress being made toward value over volume by
sharing and consolidating information about the efforts of private, public, and
non-profit sectors in one virtual location.
Just how will this coordination across sectors take
place? HHS hired an independent
contractor, announced as MITRE, to manage the Network as an outside party and
ensure unbiased support. This support
entails the convening of participants to share best practices and
thereby reduces unnecessary variation in payment methodologies, as well as
facilitates the generation of priorities and summary papers by a guiding
committee. The guiding committee,
consisting of Network participants, will address specific topics with more
detail and share their findings through webinars or other teleconferences
convened by MITRE’s support. Workgroups are to be created by the Network and
the guiding committee, with plans to meet and share with more frequency on a
variety of topic areas.
Engaging payers, providers, employers, purchasers, states,
consumer groups, individual consumers, and other stakeholders is crucial in the
transition to the quality over quantity payment model. That engagement must go farther than only the
guiding committee or workgroups. The Network will be accessible for all to
discuss, track, and share best practices that promote valuable alternative
payment models. However, engagement on
all levels is the crux for the Network.
Without sufficient participation, achieving the critical mass of payers
needed to make operational change a viable option is increasingly
difficult. Incentive is a way to
motivate business; without a critical mass of payers, the incentive is meager
for providers to change payment strategies.
Conversely, a high number of payers concerting efforts will create
incentives and speed the transition to alternative payment models.
In order to succeed in the goals set out by HHS, the Network
will serve several purposes, all of them to make the move to alternative
payment models an easy one. As the focal
point for so many sources of data, the Network connects participants so that
they may collaborate with each other.
This unification in the virtual space removes barriers throughout the
various levels, sectors and areas of healthcare. Once connected, participants will work
together to share and discover new, or existing, evidence and approaches. In addition to convening the participants,
the Network will also serve to jointly implement the newer models of payment
and care delivery across sectors, once they prove to have higher value or quality. The collection of information into a central
source permits the network to pool the data and then identify areas of
agreement in the trend to alternative payment models. All this collaboration
encourages common approaches to core issues. Using the compiled and analyzed
information, the Network’s final proposed function is the generation,
dissemination, and implementation of guides for payers, purchasers, providers,
and consumers.
Perhaps most importantly is how this information will reach
professionals and the public it will affect. The planned process is that the
workgroups will share their findings on a specific topic with MITRE, which will
then synthesize the content to produce white papers available to the
public. These documents will be available
and free of charge to payers, providers, employers, employees, consumer groups
and individual consumers, and anyone and everyone with internet access, all
through an online database. It is then, when the billions of data points have
been processed and manufactured into a precise white paper, that Big Data comes
full circle to a concise document that may seem to symbolize “less is more,”
but really shows “Big Data is better.”
Andrew Van Lahr is a current student at DePaul University
College of Law in Chicago. Mr. Van Lahr
completed his undergraduate degree at the University of Kentucky in
English. He will complete his law degree
and certificate in health law in 2017.