Informatics professionals-leading the way?

It was a proverbial shout out! The October 2012 issue of Harvard Business Review literally screamed at me as I turned to page 70. The title of the article? ‘Data scientist: the sexiest job of the 21st century’1 (emphasis added). It appears that the geeks have come of age. I smiled. We have entered the decade of informatics for the healthcare field, and the data scientist phenomenon is nowhere more evident than in the field of biomedical informatics. Developments across the field have allowed us to reach a critical point of confluence which could radically alter the future direction of healthcare—at the intersection of incentives and data.

Regardless of who wins the US presidential election, President Obama or Governor Romney, the Patient Protection and Affordable Care Act represents a remarkable piece of legislation that will no doubt change the incentives related to cost, quality, and service in care delivery. As a result of the legislation, we are moving in an entirely new direction in the way healthcare will be organized and delivered in the future. In 1980, the USA spent US$256 billion on healthcare, which had increased to US$2.6 trillion by 2010—a 10-fold increase! The projection is that if nothing is done, costs will nearly double by 2020 to US$4.6 trillion.2 That is simply not sustainable, so as a nation, we have no other choice—healthcare must change.

Services and goods produced in the US are more expensive primarily because of increases in healthcare costs which cannot be offset by increases in efficiency and effectiveness in other areas. In addition, policymakers frequently question the value of our national healthcare investment as only 55% of patients actually receive the correct diagnosis and subsequent treatment.3 The value equation is really called into question when outcomes are ranked and compared to those of other countries.4 Medicare is the single fastest growing item in the federal budget. If we don't change, healthcare will be responsible for bankrupting the nation. And, we don't want or need to do that. Informaticians know how to set us on a different course. We can lead the way.

A good friend of mine admonished me with some advice. In describing the incentives of the healthcare system, he said, ‘It's not the money!’ Then, following a pregnant pause, he followed up by saying, ‘It's the money!’ No truer words have been spoken. Since the advent of health insurance, the structure of our incentive systems has been based on a ‘do-something-or-perform-a-procedure-to-get-a-payment’ approach. As a result, the entire healthcare system from primary care to intensive care to hospice care has been built upon a financial foundation to accomplish that objective. Healthcare is performing exactly as the current incentives are telling it to perform. So, if we want to change healthcare, we need to change the incentives.

And, now, the incentives have been changed. New models of care ranging from the evolving accountable care organizations to patient centered medical homes to bundled payments and other methods are being developed where payments are made not for ‘doing’ something to individuals, but rather for ‘sustaining’ the health of individuals. To be successful in such an environment, physicians and other care providers must hold a much more comprehensive view of the individual's health and well-being in order to help sustain their health.

I harken back to 1983 when the diagnosis related group (DRG) reimbursement model was implemented nationwide. The reimbursement scheme changed from individual payments for individual services to a single payment for a specific diagnosis. Within a short 18 months, hospitals nationally had radically shifted their care delivery programs to accommodate the new reimbursement methodology. We will see the same shift over the next couple of years as healthcare delivery organizations actively embrace the accountable care philosophy and delivery methods.

At the confluence of incentives and data we have already witnessed an inflection point in data management—moving from centrally managed main frame computing to the personal computer. Now, we are experiencing yet another shift as we move from disaggregated, personal data and information to ‘big data’—the confluence of data from multiple, disparate sources that permits a comprehensive overview of the information. Healthcare will be a central beneficiary of these new models for data management, retrieval, and analysis through population health management.

The requirement for population health management represents the epicenter of the confluence of incentives and data in healthcare. And, population health management is the central tenet of every ‘accountable’ care model under development in the new care delivery models. Without it, we will not succeed. So, indeed, healthcare informaticians are the ‘sexiest’ members of the healthcare delivery team. Enjoy the moment, but more importantly, embrace the moment. We have the opportunity to make healthcare better. Let's seize upon the challenge. It's called leading the way … 

References

• Davenport TH, Patil DJ. Data scientist: the sexiest job of the 21st century. Harvard Business Review 2012, p. 70. Search Google Scholar
• Davis K. What's Working to Control Costs. The Commonwealth Fund. 2012. http://www.comonwealthfund.org/blog/2012/Jun/Whats-Working-Control-Costs...
• McGlynn EA, et al. Quality of health care delivered to adults in the United States. N Eng J Med 2003;348:2635–45. [CrossRef] [Medline] [Web of Science]
• Davis K, Schoen C. Mirror, mirror on the wall: how the performance of the U.S. health care system compares internationally. Update. The Commonwealth Fund. 2010. Search Google Scholar