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Wanted: Transparent Health Information Management Systems

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Tekisha King
June 8, 2019

The health industry is changing vastly, with a myriad of advancements in technology to sustain interoperability with health information exchange. This is aligned with the Office of the National Coordinator for Health IT (ONC). As a public health servant collaborating with government entities using the Internet of Things (IoT), my priority is to ensure protection for all Americans regardless of age, disability, equal compensation, genetic information, harassment, national origin, pregnancy, race/color, religion, retaliation, sex or sexual harassment. On May 2, 2019, the Centers for Medicare and Medicaid Services (CMS) outlined a comprehensive strategy to foster innovation for transformative medical technologies. This strategy aims to improve patients’ access with emerging technologies in support of the Trump Administration to lower cost, increase access and improve the quality of health care for all Americans. The definition of interdependent involves two or more people or things dependent on each other. This is equivalent to government intervention in health care. Currently, health information management (HIM) systems are a substructure priority that requires immediate attention from local, state and federal sectors.  

As we evolve from a fee-to-fee service to a valued-based care model centered around primary care for government health programs—Medicare, Medicaid and CHIP—many still bid to elude business partnerships with the government. In 2010, the Patient Protection and Affordability Care Act (PPACA) required interoperability to promote the adoption and meaningful use of health information technology under the Health Information Technology for Economic and Clinical Health Act (HITECT). However, many failed to adhere, which resulted in revenue loss and/or business closure. Effective collaboration is imperative for all sectors to focus deeply on the delivery of health care services in our consumer-centered economy. In addition, consumers are still uninsured or underinsured with one to multiple chronic medical conditions. Consumers often face high out-of-pocket costs and are highly impacted by social determinants impeding their health status. Furthermore, the aging population is retiring, the disabled population demands more health services and health costs continue to upsurge.

On April 22, 2019, the Department of Health and Human Services (HHS) delivered the value-based care transformation with primary care in 2020 to empower patients and providers to drive better value and results with five primary care first and direct contracting payment models:

  1. Primary Care First (PCF)
  2. Primary Care First – High Need Populations
  3. Direct Contracting – Global
  4. Direct Contracting – Professional
  5. Direct Contracting – Geographic

The primary focus of this model is intended to focus on health care services with providers and patients to yield quality health outcomes. For instance, telehealth services are emerging with Medicare, Medicaid, and Emergency Medical Teams to allow effective collaboration with provider(s) delivering urgent medical care to vulnerable populations with complex medical conditions in emergent situations.

The primary care models would allow government programs to decrease hospital re-admissions, monitor medication adherence and promote telemedicine services to vulnerable populations under the government health plan programs. According to Forbes Magazine, the Trump Administration is supportive of single-payer Medicare to allow seniors to pick private health plans and allow private insurers to expand Medicare Advantage with more benefits. Regardless of the current payment structure for government programs, fraud, neglect and abuse have escalated tremendously, wasting taxpayers and government funding in health care. On February 14, 2019, the CMS Innovation Center implemented the Emergency Triage, Treat, and Transport (ET3) models with greater flexibility to ambulance care to address emergency health care needs for Medicare beneficiaries. The Emergency Response Medical Teams should be inclusive within the treatment of health care services for consumers to produce quality health outcomes. With continuous technological advancements in health care from hospital to long-term care settings, health information requires transparency in real time for medical personnel to adhere to the valued-based care model structure and to improve health outcomes.

Management and administration leaders should be interdependent. Yet they are largely divided and clueless with the primordial goals to support a, “Medicare for All” health care system. The Harvard Business Review defines leaders as artists who tolerate chaos and lack of structure while preventing premature closure on important issues. Managers seek order, control and rapid resolution of problems. For instance, Humana’s CEO is the nation’s biggest provider of Medicare Advantage but became the single payer against, “Medicare for All.” The facts add up to minimizing out-of-pocket costs, enhancing provider network restrictions, and providing  members with inclusive in-network options. Regardless, health care leaders are disaffiliated and too opposed to unify. On the other hand, United States Senator Bernie Sanders of Vermont advocates a single payer version of Medicare for All that would replace the private health care system while eliminating co-payments and deductibles.  It would  allow Americans to pick doctors free of health payers restrictions and provider network rules. Effective collaboration in real-time with health information allows everyone to be involved. Collaboration allows everyone to maximize health services effectively in emergent and non-emergent situations in support of the proposed valued-based care model of 2020.  Where do you stand with the implementation for a single-payer, “Medicare for All,” proposal under the Valued-Based Care Model of 2020?

Tekisha King
Health care Pioneer
[email protected]

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