Evolution of IT in Healthcare

Mark Caron, CEO, Geneia
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Mark Caron, CEO, Geneia

Mark Caron, CEO, Geneia

How has your IT operating model changed during the last five years in Healthcare industry?

When I joined regional health plan Capital BlueCross in 2011, I became their first Chief Information Officer who reported directly to the CEO and an integral member of the company’s senior leadership team. My predecessors were more likely to be Vice Presidents with multiple layers of management between the senior leadership team and them.

The evolution of the IT operating model from serving as a traditional support and order-taking organization to a strategic and aligned partner to the business mirrors the elevation of the IT leader to senior leadership.

The demands and expectations of healthcare organizations, and IT in particular, have necessitated this change to consultative, trusted business partner. Value-based care, for example, means healthcare organizations need new enabling technologies in order to measure and improve patient outcomes, health and the associated costs.

  ​The evolution to more agile and outcomes-based model also means technology leaders need to be willing to sunset legacy software   

What do you think are the biggest obstacles that technologists face in working in a more agile and outcomes-based model?

Healthcare is evolving quickly from a fee-for-service system to value-based care.

A mere six years ago, no Medicare payments were under risk arrangements. Today, more than 30 percent are, and it’s expected to be 50 percent by 2018. Similarly, health plans have created many value-based contracts. Estimates suggest there are approximately 900 accountable care organizations (ACOs) serving 31 million Americans, and more than half of them include a hospital. That’s why experts have predicted that by 2018, 90 percent of all hospital payments will be value-based.

This evolution means pure technologists can no longer be successful in healthcare organizations. Instead, technology leaders need a deep understanding of value-based care and their organization’s strategy to succeed in its risk-based contracts. In order to align the organization’s information technology strategy with the overall business strategy, technologists need business acumen and industry knowledge.

That’s why we’re seeing more technologists participate in CHIME (College of Healthcare Information Management Executives) and HIMSS (Healthcare Information and Management Systems Society) educational and professional development programs. In addition, technology leaders who understand their organization’s business demands are much better positioned to gain the trust of their peers and become the type of valued partner healthcare companies need and increasingly expect.

The evolution to more agile and outcomes-based model also means technology leaders need to be willing to sunset legacy software, and in some cases, the people and vendors who supported those systems. For those who do, they gain a streamlined and more comprehensive approach to risk-based contracts, and often save millions too. For example, one of our health plan clients had cobbled together and repurposed eight of its existing software products from seven different vendors to try to manage its value-based contracts. The plan sunsetted these systems, saving more than $3 million just in annual licensing fees and improving the performance of its value-based contracts.

What set of skills do you think is required for the Healthcare technology leaders to be successful in the new enterprise landscape?

The skills required for healthcare technology leaders to be successful in the new enterprise landscape include a thorough understanding of the technology, security and cybersecurity, cloud capabilities, virtual technologies, and value-based and transitional care. Technology leaders also need softer skills to build trusted, two-way partnerships with the company’s other senior leaders.

Which growing or future technology innovation are you personally excited about?

We are in a period during which the exciting technology innovations have the potential to have a very meaningful impact on the healthcare industry as a whole, and in particular, at-risk and rising risk patients and populations—and to do so cost-effectively.

Take virtual care, for example. We know many patients, especially millennials and seniors at-risk for falls or illness, want to have a telehealth option. In fact, a recent Accenture survey of 1,501 consumers found 78 percent are interested in receiving virtual care. The technology – and healthcare adoption of this technology—are rapidly catching up to consumer interest.

I am equally excited about remote patient monitoring for its ability to detect disease progression sooner and facilitate earlier interventions by the patient’s care team to prevent unnecessary emergency department visits and hospitalizations.

A statistically-significant Geneia study of patients with diagnosed heart failure demonstrated the success of remote patient monitoring. In short, the heart failure patients in our study fared much better than the control group:

• Risk Score Stabilized: A 2 percent increase in the study group compared to a 31 percent increase in the control group – indicating a slowing of disease progression for participants

• Hospital Admissions: With a net 45 percent reduction in acute hospital admissions, they spent far less time in the hospital

• Medication Adherence: Increased by 37 percent

• Financial:  Annual savings of $8,375 per monitored patent

I am similarly excited about 3D printing technology, implantable intelligent devices, broader application of machine learning to diverse data types and sources, increased adoption of cloud services in order to lower costs and time to deployment, and the FHIR (Fast Healthcare Interoperability Resources) standard to remedy the seemingly intractable problem of interoperability.

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