But as care delivery becomes more complex, and as communications systems improve, there is a chance for both parties to reach across the aisle. Indeed, managed care organizations and other payers already are sharing data with providers that are leading to quality and cost improvements.
Clinicians in the emergency department today are educated using evidence-based drug data supplied by managed care organizations and are recommending drugs that are both effective and budget-conscious. These data resources are expanding into areas such as high-cost imaging, allowing clinicians to confidently pursue treatment options that may be more appropriate for the patient and more financially sustainable than high-dollar pictures.
In addition, information technology now employed in medical home pilot projects (some of them sponsored by insurers) features search engines that can scan a patient's medical records to identify tests or processes that are missing or late. Information systems now prompt physicians to ask for particular procedures or tests when a patient presents with an abnormal lab result or other anomalous condition. Unlike the last go-around of health reform, quality measures now can be tracked and an appropriate balance between cost and quality can be achieved.
As a physician, I am excited about the new analytic, evidence-based tools now at my disposal because they allow me to exercise my training and judgment to make better decisions on behalf of my patients. Particularly exciting is the ability to track treatment patterns of high-risk patients -- cases in which outcomes and costs often are problematic – and to modify treatment when necessary. Improved technology, and enhanced cooperation between providers and payers, allows for closer tracking of these patients once they leave the hospital, reducing the need for readmissions that cost the system and demoralize the patient.