By Anita Pramoda
Founder, Owned Outcomes, 2014 HITLAB World Cup 3rd Place Winner

If we are not excited, then we are not paying attention.

We are fortunate to be living in a significant time of great innovation. The healthcare industry is on the cusp of a sea change due to the transformative possibilities of payment reform. With the Comprehensive Care for Joint Replacement program (CCJR), the implementation of mandatory bundling by Centers for Medicare & Medicaid Services (CMS) is merely a prelude to the widespread reversal of existing payment norms. Whereas fee-for-service payments currently comprise about 75% of CMS payments, the reality of a 50% value-based care system may not only be preferable, but inevitable. As with reform of any type, there are always those who will be reticent to jump on board.  We want to hear them out, learn from their opposition and, if possible, help them embrace the impending realties and create better outcomes.

It seems that both patients and providers are poised to benefit greatly from CCJR and other Bundled Payments for Care Improvement (BPCI) initiatives. These benefits will be measured tangibly, but the intangible good to the psyche of the system as a whole could be sizeable. This belief leads us to the following query: When embarking on new reforms, what role should inclusivity play? We humbly propose that it is paramount. Not merely due to a sense of equity, but because empowering all who may be affected (patients, physicians, hospitals, and administration) offers the potential of producing the most promising results. In regards to CCJR, items we feel worthy of discussion include:

·       Would it not be prudent to engage post-acute providers in the development of equitable risk sharing agreements?

·       Can risk adjustments be used to help patients and remove incentives that result in procedures being conducted too early or postponed too late?

·       Could we increase patient compliance by fostering the institutionalization of soft elements used by practitioners, such as trust? 

·       Due to the materiality in the costs of orthopedic devices, could we invite device manufacturers to play a more prominent role?

·       What quality measures or explicit reimbursements can we use to address patient care coordination, to improve outcomes and patient satisfaction?

There are a wide range of other questions with ramifications that are far reaching and deserve thoughtful, informed discussion. The use of technology, data, and analytics as tools to illuminate these discussions is a central focus of our organization. We also revel in the chance to engage in interdisciplinary conversations that both broaden our knowledge base and help us to focus on the important tasks at hand.

We congratulate the HITLAB Innovators Summit℠ for providing a collaborative forum for the exchange of ideas regarding the challenges facing healthcare. It is clear that our past participation has informed our thought processes moving forward and for that we are grateful.  The HITLAB Innovators Summit and the excellent work coming out of the HITLAB World Cup℠ should not only be admired for their worthwhile intentions, but lauded for their impressive results.