When Farzad Mostashari, MD not too long ago sported a Federal business card his principal mission was to stimulate and evangelize the adoption of electronic health records (EHR) in his capacity as the lead official for the Office of the National Coordinator for HealthIT (ONC). This important market transformational role was enabled by the American Recovery and Reinvestment Act (ARRA), and in particular the provisions to ‘HITECH‘, the Health Information Technology for Economic and Clinical Health Act signed into law on February 17, 2009:
‘to promote the adoption and meaningful use of health information technology.’
Amidst ‘silo-ed medicine’ the enabling role of health information technology and specifically EHRs to the care management, care coordination and generally the principal upside of the ‘managed care’ vision has been recognized for quite some time. In fact, ‘clinical integration‘, i.e., a network wide EHR platform, shared by independent physicians who were otherwise competitors in a specific market (absent legal integration) was one of the exceptions if not ‘safe harbors’ to antitrust vulnerability. In other words, a ‘shared healthIT spine’ of sorts allowed physicians to collaborate with each other without getting ‘married’ – if you will.
Since the passage of the Affordable Care Act (ACA), the ‘urge to merge’ is strong particularly at the hospital or institutional health system level, with many corporate parents acquiring medical practices at a pace unwitnessed during the prior ‘integration generation’ circa the 1980 – 2000 vertical integration and subsequent turbulent unwinding timeline.
Inside the ACA the majority of the ‘chop wood and carry water’ provisions of the anticipated transformation or ‘disruption’ are clearly laid at the doorstep of ACOs and the broader ‘accountable care’ framework it has set into motion via both Government and derivative private sector initiative.
Inside this market shift and not un-noticed by many healthcare ecosystem stakeholders (both pre and post passage of the ACA), many argued for the modulation if not regulation of the institutional ‘integration impulse’. Absent restraint, many provider mergers would amount to de-facto ‘too big to sail’ (i.e., more costly) enterprises via asset concentration for anti-competitive pricing leverage. Against this ‘unintended consequence of the law’ (more costly vs. less) some have stepped up to lend support to physicians as the principal organizers and aggregators of clinical delivery (if not financing) assets. The theory goes, un-beholden to costly hospital infrastructure, physicians are the ‘free and informed agents’ to competitively purchase and allocate needed clinical assets across the care delivery continuum.
Clearly the wildcard in this formula is an ’empowered network of physician aggregators.’ Since most physicians are NOT infrastructure nor business savvy per se, a third party enabler to harmonize performance around this ‘triple aim’ (better care, better outcomes, lower costs) fueled vision is essential. In other words, build and support the crosswalk from volume value where care is not incentivized by unit volume to support incomes and lifestyles but what’s right for the patient.