par Sean Ruck
, Contributing Editor | May 17, 2019
From the May 2019 issue of HealthCare Business News magazine
Steve Sisko was in IT before most people knew what IT was.
He started his career in 1982 and moved into the healthcare IT realm in 1993. His background as a developer and his decades of work with payors and the financial side have given him a unique perspective about some of the areas where the wheels are falling off the healthcare bus, and some ways organizations outside of the healthcare industry might get those wheels back on.
Sisko has written and blogged about one of the topics that ties into a healthcare shortcoming that’s become a main topic in recent years: the shift from treatment to prevention and fee-for-service to pay-for-performance. Sisko sees technology playing a big part, but the people behind the software still have a lot of deep thinking to do, and if they’re being thorough, their work will include the study of social determinants of health.
As he explains it, social determinants are barriers to patients getting the right kind of care. These determinants cover a range of challenges such as access to transportation to obtain care, proper nutrition, safe housing, availability of caregivers, or even just living in a household with potential hazards that aren’t being addressed.
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So where does technology come into the picture? The answer is twofold. At this stage, a lot of the work is still information gathering to get that big data status, in order to identify the top issues to focus on. Data also need to be entered into systems in a consistent way. The less structured the input, the more difficult it’ll be to extract useful information.
The second part of tech’s role is tied to the EHR. Once factors for care are defined and plans to overcome social determinants are created, the EHR will lead the charge. If every hospital’s looking at the same big data set, the best-case scenario would be for hospitals nationwide to follow a standard approach to input data consistently. This would also allow for findings to be more readily integrated into clinical workflows and systems used through a hospital, health system or other healthcare organization. Standardization would also allow for widespread automation surrounding predefined use cases.
Addressing barriers to health offers tangible benefits
Of course, healthcare is a business, so the question is, “where’s the value to service providers and payors?” Weighing the upfront cost-to-benefit has some payors, health systems and hospitals a bit worried. Payors want to see medical loss savings and hospitals want to maintain revenue streams: “They’re thinking if they spend money on getting grandma an air conditioner so she doesn’t have her asthma attack, the hospital is not going to get that emergency room revenue when grandma doesn’t present,” said Sisko. “The whole idea of preventing emergency treatment and inpatient admissions is contrary to the business model of hospitals today. The fact is that hospitals, by their very fee-for-service focus, are dependent upon that revenue. If we start shifting money to social services as things stand now, hospitals will be hurt.”