The Digital Primary-Care Physician

The old saw “follow the money” may be trite, but it is overwhelmingly the most accurate predictor of future trends.

The recently released Rock Health 2012 funding report leaves no doubt as to where venture capital believes healthcare is going. Of the $1.4 billion invested in new healthcare companies in 2012, software jumped 19 percent and digital health investment by 45 percent. Conversely, investment in traditional health care fell by 4 percent in biotechnology and 19 percent in medical devices. Considering overall investment jumped by 45 percent to $1.4 billion, a drop in year over year investment in biotech and medical devices is significantly compounded.

Health consumer engagement led the 134 digital health companies raising more than $2 million each, and more than half $5 million or more, consumer engagement companies with $237 million were followed by telemedicine at $143 million and EHR companies with $108 million.

These are big bets on the future. While most will fail, CMS, which has settled its focus on primary care, will likely determine the survivors. The Center for Medicare & Medicaid Innovation outlines its vision and mission in a webinar for primary-care physicians. Although the ACA is really insurance reform, and not healthcare reform, CMS is focusing on wellness, chronic disease management, and improved care to manage costs through high-performing primary-care physicians.

While the results at this early date are not encouraging, the strategy is arguably on point, but it is not going to happen without the right tools in place to support it. The CMS presentation states that payers are willing to invest, along with CMS, in a test of “enhanced” primary care, and supporting technology is where a good portion of that money should go. It will be the engine that drives achieving these goals.

The test, according to CMS, may result in a national payment policy for primary care. Winning physicians will be those that are best equipped to out-perform the standards, and now is the time to start. But they will have to choose wisely.

Companies with tools and services that enable care coordination, distill mountains of data into usable information and present it in ways where office staff can pick up the bulk of the work load will be potent agents of change. The addition of (preferably integrated) tools that address health literacy, encourage medication and care compliance and enable patient connections and engagement with their physicians and staff through enhanced patient experience will separate the truly high performers from the rest of the pack.

The plan for patient and primary care outlines their intent clearly:

Practice Redesign

• Provision of comprehensive primary care functions

• Effective use of data to guide care

Payment Redesign

• Per-beneficiary-per-month (PBPM) care management fee

• Shared Savings opportunity

Their “comprehensive primary care functions” require the right technological tools to work:

1. Risk-stratified care management

2. Access and continuity

3. Planned care for chronic conditions and preventive care

4. Patient and caregiver engagement

5. Coordination of care across the medical neighborhood

The real goals, which are not outlined, and where the smart money is being invested, are those care-coordination tools and technologies that effectively:

• Eliminate redundant imaging and laboratory diagnostics,

• Eliminate unnecessary hospital admissions and readmissions,

• Halt or reverse progression of chronic conditions to higher levels of complexity,

• Reduce or eliminate ER visits,

• Increase usage of generic Rx and compliance,

• Reduce medical specialty visits, and,

• Improve the quality of services, patient satisfaction and outcomes.

The bad news is that your EHR system is probably inadequate. The good news is that the smart money is following the tools and services that can bridge the gap.