BioPharma: EHRs Can Expand Quality and Scope

HIT Perspectives Biopharma Insights – November 2015

EHRs Can Expand the Quality and Scope of Physician Practices

By Brian Bamberger, Life Science Practice Lead

Electronic health records (EHRs) are a new tool for many physician practices, particularly with regard toward improving the treatment of diabetes, coronary heart disease and other chronic illnesses. EHRs can help physicians and practice staff take the necessary step of identifying at-­­­­risk patients for targeting interventions, then following up with various treatments and medication therapies as part of standardized treatment plans following association guidelines. The result: safer and improved quality of care for patients, an expanded scope of practice, potential new sources of revenue and measures of practice quality.

Drivers. The emphasis on using EHRs to identify and treat the chronically ill is a somewhat recent development. It is fueled by the convergence of several drivers:

Rise of chronic illness. More than 133 million Americans currently live with a chronic condition. The incidence of chronic illness is accelerating as Baby Boomers age and younger generations become more sedentary and have unhealthy diets. Chronic illness is a major driver of health care costs. For example, 86% of all health care spending in 2010 was for people with at least one chronic medical condition. The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity.

Costs of specialty medications. A related driver is the skyrocketing costs and use of specialty medications, which are used to treat chronic illnesses. Specialty medication outlays are expected to quadruple to $402 billion by 2020, and account for 50% of overall drug costs by 2018 for commercially insured individuals. These drugs are expensive, with costs per month generally ranging from $2,500 to $50,000 per patient. Eight of the 10 highest revenue drugs in 2016 will be specialty medications. Moreover, the cost curve continues to climb as new blockbuster therapies come to market.

Registries. Disease or patient registries are collections of secondary data related to patients with a specific diagnosis, condition or procedure. Their use and content are expanding exponentially. Coupled with use of EHRs, registries are powerful tools that help physicians — especially in small family and internal medicine practices — track and manage chronic diseases within their patient panels. Registries can also play an important role in  postmarketing surveillanceof pharmaceuticals.

Meaningful use (MU). MU is one of a number of public and private payer mandates that require physicians to use EHRs to achieve improvements in quality, safety and decision support for such high-priority national health status problems as obesity and diabetes. It also requires physicians to increasingly engage patients in their own health care.

Quality reporting and evaluation. EHRs can be used to track clinical patient data across a wide range of conditions and help physicians measure and report quality indicators against various payer and government requirements.

New payment models. The world is slowly but surely changing from fee-for-service reimbursement to payment models based on pay for performance, quality and value-based based care. All of these link physicians’ financial health more closely to the health of their patients.

How it works. Providers having electronic health information about their patients can more quickly and easily identify those who suffer from specific conditions. Because EHRs link to patients’ insurance information and medication histories, the physician can identify which patients are appropriate and eligible for specific preventive and treatment measures for their individual conditions as well as all medications they are currently taking — or not.  For example, providers might use EHRs to:

Identify which hypertensive patients have their blood pressure under control, the medications they are taking and their adherence to drug therapies.

Determine how many diabetics have their A1C in the appropriate range and have received screening and counseling.

Identify patients for whom disease-specific education is appropriate. This includes third-party educational materials that can be provided via the EHR and a partnership by pharmaceutical companies.

See which patients may be eligible for new drug therapies and have abandoned previous therapies.

Similarly, EHRs can help providers work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes — yet another metric used for quality and reimbursement purposes by Medicare and private payers.

Impacts. It is clear that use of EHRs can help physician practices improve the quality and safety of patient care. Doing so may help expand their scope by identifying and performing the various expanded services associated with chronic diseases, such as office visits, monitoring, vaccinations, counseling and patient education. This, in turn, directly relates to practice revenue streams. In short, EHRs are a required tool for physicians, and all new treatments or treatment changes need to be integrated into EHR work flows. While many physicians are not excited about this, they will grow to understand how EHRs create clinical value as opportunities for expanded services and reimbursement for physician practices increase.