We Need a Platform

Date: August 10th

Time: 7:25am

Location: Metro North, just south of Ossining

We are going to be spending some time today wrapping up the selection phase of our Digital Health Accelerator program, which prompted me to reflect on how we arrived here.

Towards the end of 2011, as the New York Medicaid Redesign Team’s Health Home program started to come into focus, we realized we had a problem. (If you aren’t familiar with the program, here’s a link: Health Homes) In short, the program represents a significant step toward moving from a “fee-for-service” model of healthcare delivery, to a “team-based” model. The Health Home Program is very similar to Accountable Care Organizations—it is a program designed to create organizations, or clusters, of healthcare providers who are collectively accountable for the care of a given group of patients. And the financial incentives are aligned such that healthcare providers don’t increase revenue by simply doing more work, as in a fee-for-service structure, and they are rewarded for better outcomes.

What all of this boils down to is that the payment system is shifting to one that rewards the healthcare community for working together, and healthcare providers are changing their workflow to collaborate with the other healthcare providers who are treating the same patient simultaneously.

How many of us have a story about a loved one who was harmed because the healthcare providers who were simultaneously treating this loved one didn’t know what the other was doing? The system failed them. They could have, and would have, done a better job had they known what the other provider was doing, and coordinated their treatment plans.

Now . . . the problem: We have healthcare providers increasingly forming team-based care organizations called ACOs and Health Homes. These are individual private practices or hospitals, each with their own electronic health records system which helps automate the workflow of their institution. However, there is no platform or set of workflow tools to help support the new team-based model of care. The patient may interact with four to six different healthcare providers throughout their treatment (and now the payment system is rewarding those providers to collaborate) but the providers and patients still don’t have tools to help them collaborate.

Enter the SHIN-NY: The Statewide Health Information Network of New York. Over the past five years, New York has been building a network which links healthcare providers together. This consists of both the policy framework and the technical architecture to provide them with a platform for collaboration. Healthcare providers have been working with NYeC, the Department of Health, and those Regional Health Information Organizations (RHIOs) within their communities to develop and implement the policies necessary to establish trust for patient record-sharing, and to put into place the technology with will allow records to flow between healthcare providers. This has set the stage for the development of the workflow tools needed to facilitate team based, collaborative care—along with setting the stage for a new generation of health IT.

The New York Digital Health Accelerator was designed to harness the SHIN-NY—a platform for collaboration—and to catalyze innovation to produce new software tools for this new market.

But the rest of the story will have to wait until my next post.