Coordination of care will also be critical to Medicaid reform, and technology and electronic health records will play a significant role there as well. “Chronic care patients are likely to have several different providers,” said Enthoven. “Without a good system of electronic health records, a lot of time can be wasted and data can be lost. Errors are more likely. Teamwork is important in treating chronic care patients and electronic health records are at the heart of that.”
“Most complex care patients go many places — surgery centers, specialists, etc.,” Chopra said. “Today each of those places operates in a silo. More effective information sharing technologies are important because doctors can only manage patients better if they have all the data.”
Oregon is one state that is already taking steps toward better coordinated care. The Oregon Legislature, in a bipartisan vote, recently directed the state to create coordinated care organizations (CCOs). In July, the state officially launched the new CCOs with 260,000 patients. The goal is to coordinate mental and physical health care and focus on prevention. CCOs will also provide more support to patients with chronic conditions. Over time, officials said, patients with complex conditions can expect their doctors, nurses and therapists to coordinate their work and be better prepared to help them handle their treatment between visits to a clinic.
Overall, states are taking different approaches to working toward the ACA provisions. Some states, such as Maryland and Colorado, are integrating Medicaid reform and health insurance exchanges and moving them forward together. Others, like Montana and Wyoming, are moving forward aggressively with Medicaid provisions and new eligibility systems but are not focusing on health insurance exchanges yet. “Which approach is better really depends on the state,” Camillo said. “With either approach, coordination and communication are essential to success.”
Delivering Improved Services
Technology will also likely play a significant role in health-care delivery in the future. There are already numerous examples of how different types of technology can be used to deliver a faster diagnosis or to simplify doctor/patient interactions. Patients take photos with smartphones and email them to their care provider for evaluation; doctors use Skype to video conference with chronic care patients and monitor their conditions from home using computer-based medical devices; large monitors and video conferencing allow a surgeon to update a patient’s family from the operating room immediately after surgery rather than making them wait for the surgeon to clean up and change clothes to update them in person.
The use of technology in health-care delivery also has potential to reduce costs and improve care in underserved or remote areas. Dr. Rafael Grossmann Zamora is a trauma surgeon at Eastern Maine Medical Center in Bangor, Maine. Zamora and his team are using video over a Wi-Fi network utilizing an inexpensive iPod Touch to conduct consultations for acute trauma patients, thereby extending the virtual presence of a specialist over a vast area instantaneously at a very low cost.
“This is about improving patient care and increasing the efficiency of the trauma system,” said Zamora. “Technology is helping us overcome high demand for a shortage of specialists in rural areas.”
When a hospital needs advice or a consultation, staff members call Zamora and, via big screens and video conversations, Zamora examines the patient and consults with doctors on the best approach to the patient’s care. While the traditional approach of in-person consultations is time consuming and inconvenient, the mobile technology solution has proven fast and inexpensive.