Technology vies to aid physician reimbursement with new payment models

Girish NavaniEditor’s Note: Girish Navani, CEO and president of Westborough, MA-based eClinicalWorks, spoke with Medical Economics about the present and future of health information technology (HIT). Here is the full interview. Excerpts of this interview were published in the October 25, 2013 issue as part of the publication’s ranking of Top 100 EHR companies.

Medical Economics: In what ways is technology transforming medicine?

Navani: I think the last decade has been predominately about digitizing the delivery of care, and that's helped in reducing errors that creep in when information is not electronic.  Drug interactions might be a good example. Technology also helps streamline patient flow within a practice. It gives physicians the ability to better manage appointments, check-ins, and streamline triaging. You can better bill for those patient visits in a timely fashion, and that hopefully results in better and more timely reimbursements. So, technology has helped with what I would call the foundation of digitizing care by making information now understandable and accessible for the future. 

Medical Economics: If you could think about the delivery of medicine in the next 5 years, how will it change? How important will technology be in helping to guide this evolution?

Navani: Technology will change healthcare delivery. But also I think reimbursement models will create a catalyst for technology to change.

Today’s health information technology is too focused on the documentation of the visit. It is changing how technology is being used for coordinating care for patients. Care planning and care management will probably be the focus, and primary care will derive significant benefits as a result of it. That change I think is pretty relevant. And in 2013 we’ve seen the early stages of it, whether it was the formation of accountable care organizations or Patient-Centered Medical Home initiatives. 

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Technology is going to impact primary care reimbursements in a positive way, as long as it can be used for managing and coordinating care. 

I think in 2013 we are still amidst the transition where we now understand that our reimbursements will be tied to outcomes. I don’t think we have yet changed the consumers’ behavior around looking at those indicators in terms of how and where they derive their quality or care. But if you ask me, the question over the next 5 years, we’re definitely moving to consumer-centered care. The patients will make decisions based on price, quality, and also convenience in terms of how and where they get their care. 

Again, it will go faster than you and I expect.  My gut tells me if we look back within 12, if not 18 months, we will be pleased that healthcare has moved past digitization of technology to using it as a vehicle for better decision making. 

Medical Economics: We are 3 years into Meaningful Use. Our government continues to incentivize and will ultimately penalize physicians for not adopting EHR systems. Why has it taken such a massive push to get physicians to adopt?

 Navani: The challenge with HIT is that it’s trying to change not just the technology spectrum, but behavior. We are also asking the end user, who is actually the decision-maker, the physician, to use technology to enter data. That is very uncommon, if you look at most industries. The decision-maker usually looks at the data and makes decisions, and does not get so involved with data entry. That is a hard transition to start with. 

EHRs have become predominately used now, and I think the incentives have something to do with the adoption. I am not a proponent of whether it’s good or bad. Moving forward, we will need to push harder for what technology can eventually deliver for better delivery of care.

Medical Economics: What happens in the HIT market when the government incentives to adopt EHRs run out?

Navani: I don't think the incentives are ever going to run out.  There are so many incentive programs today for quality of care.  You can look across the country and every insurance company offering an incentive of some sort.  Whether it's a Patient-Centered Medical Home, or whether it's an accountable care organization.  The incentive for technology is not going to go away. 

The right to earn a physician’s business is going to get harder, because you will be in what I would call a replacement market.  You need to have a better product and a better service, and you need to be able to keep your customer base.  I think size will matter, at some point, just like it did in the cell phone business.  Verizon and AT&T built more connections, so they got more subscribers.  I think you'll see some of that, as well.  I wouldn't be surprised if a larger business that can't invest in research and development, and can't show the same top line growth will get pressured by stock prices or investors to merge with something else. 

Medical Economics: Will we see more consolidation?

Navani: I think consolidation happens in every market, in every industry, not just technology. There is what I call the euphoric phase of any technology adoption, when a lot of new stuff comes out. And then the companies and the products that are available start establishing and gaining market share. Everyone ends up with a piece of the pie.

Then comes a time period when publicly-traded companies valuations skyrocket with the anticipation of a gold rush. Then comes the realization phase that it’s going to get harder, it’s going to get tougher, and the profit margins are going to have to be earned and not given. In that time period, some companies fall because they are weak, and they can’t keep up. Other companies fall because their shareholders don’t want them to stay in the game anymore. 

We are headed for consolidation, without a doubt. It’s not just going to be the smaller or the insignificant. I think you will find companies that have not built customer bases or are strongly relying on investors to fund their next generation of products having to either consolidate or merge. It happens in every industry, and it’s going to happen in our industry. I wouldn’t be surprised if you see some reasonably large businesses next year get acquired or merge with each other. 

Medical Economics: We live in a mobile world. How important is mobile technology to the future of medical delivery overall?

Navani: I think we're getting used to the form of an iPad.  For example, I choose to carry my iPad home now, most of the time, and I don't carry my laptop anymore. You should expect the physician to be thinking the same way.

So mobility, whether it's a smartphone or an iPad, is going to be the expectation in the future.  Cloud-based computing, if you're not invested as a company, building that infrastructure, capability and expertise, I think you're going to find it hard. 

It's not just the form factor of the device.  It's also the capabilities on that device.  That's going to matter a lot. Alongside of that, I think voice recognition is going to play a big role as well.

Medical Economics: Let’s talk about a fast growing segment-personal health products. How will patient communication change as a result of this kind of technology?

Navani: I think along with the change that we talked about in the delivery of medicine over the next 5 years, one that I am quite certain will emerge even more is the consumerism of healthcare.  Where the consumer, the patient, starts asking or demanding services, devices or access to healthcare technologies that will compel delivery organizations to meet.  And it will be in two areas. 

It will be about awareness, which means the patient knowing what to do, and when to do it. Compliance is important too. The core capability of our healthcare systems is going to require the engagement of patients; the consumer will have a closer connection to the provider.

Medical Economics: What do you think HIT vendors will be talking about in 5 years as it relates to technology platforms/applications?

Navani: We won't be talking about electronic health records as a product.  We'll be talking about health information technology that builds better bridges of care with patients and providers.  This will encompass an EHR, it will include analytics, it will include care coordination. It will need to work synergistically so that patients are able to interact with providers for better care delivery.

Girish Navani co-founded eClinicalWorks in 1999 and serves as CEO and president. Prior to founding eClinicalWorks, Navani led successful information technology and business initiatives at Fidelity Investments, Teradyne, and Aspen Technology. He holds a Master’Aps of Science in Engineering from Boston University.