Prepare for a Work Environment Organized Around Accountable Care
The healthcare environment is changing. The industry is moving from volume to value, provider-centric to patient-centric, fee-for-service to bundled payment and delivery of extreme care to accountable care and population health management. Nurses will play a growing and vital role if they can master, adopt, use and promote technologies related to patient engagement, telemedicine and mobile health, population health management, clinical integration and performance management.
Accountable care is being touted as the framework for healthcare reform. Accountable Care Organizations (ACOs) put patients at the center of healthcare decision making and give groups of healthcare professionals the responsibility for care coordination across settings. Nurses, including advanced practiced registered nurses (APRNs) such as clinical nurse specialists, nurse practitioners and certified nurse midwives, have the knowledge, experience and skill to support ACO goals: deliver high-quality, patient-centric care to populations and communities and control or reduce costs.
Nurses can play important roles as coordinators, communicators and quality managers. Nurses deserve the opportunity to coordinate care across varied care settings, including primary care and specialist physician practices, pharmacies, imaging centers, long-term care and rehab facilities, and home care. They can also add value as communicators, explaining treatment options to patients and families and sharing insights related to disease and condition risk factors, causes, diagnoses, discharge instructions and prevention of complications and readmissions. Finally, they can improve quality through evidence based nursing practice, data analysis and evaluation of cost and quality measures.
To fulfill these vital roles, nurses must master a variety of technologies, among them:
Patient engagement technologies: Patient engagement occurs when patients and families become actively involved in their own care. It involves "actions individuals must take to obtain the greatest benefit from the healthcare services available to them, "according to the Center for Advancing Health. Nurses can support engagement through the adoption, use and further development of patient portals. Engagement happens when portals deliver access to an electronic medical record (EMR) system and personal health information, online appointment scheduling, and personalized, condition-focused alerts and reminders in the form of e-mails, automated telephone calls or text messages.
Telemedicine and mobile technologies: ACOs need to extend the boundaries of care beyond the confines of the traditional hospital or primary care practice. Telemedicine and mobile health facilitate patient engagement, while helping providers deliver more cost-effective care. While telemedicine embraces applications and services that include two-way video communications, e-mail and wireless phones, mobile health features multiple technologies integrated into the increasingly wireless and mobile healthcare delivery system. The New York Times has already reported on the growing significance of mobile devices in nurse education, while Apple developed a list of top apps for nurses now available in the iTunes store. Meanwhile, the market for remote patient monitoring topped $204 million in 2012, according to GBI Research.
Data aggregation technologies: Nurses will play a growing role in data aggregation, a process that involves data collection, analysis, use, reporting and delivery of feedback throughout the organization. ACOs will use process and outcomes data to measure what they achieve for patients and population-based communities. This means offering information to influence care decision making at the point of care through clinical decision support (CDS) and integrating responses from patient experience and satisfaction surveys. Even ACOs that aren't associated with the Medicare program will need to achieve accountability on measures like patient safety, patient/provider experience, care coordination, and preventive health. The best data aggregation technologies will support APRNs with easy access, user friendly search, and training in data collection, analysis, use and reporting.
Population health management technologies: ACOs are designed to improve outcomes, which should improve population health management. ACOs must know a population's health status and utilization patterns to develop targeted wellness and prevention programs. That, in turn calls for technologies that perform data mining, risk stratification and analysis. Nurses will engage with longitudinal tracking mechanisms that integrate with CDS system for real-time patient management, while also conducting searches for disease trends, diagnoses, procedures and missed appointments.
Other technologies will be equally vital to nurses within ACOS. Among them are clinical integration technologies that offer integration of patient medical records, clinician/physician patient care portals and notifications and reminders; performance management technologies that provides quality measures, best practices, evidence-based data, regulatory compliance, real-time reporting, and benchmarking; and reporting technologies that feature patient health record integration, standardized reporting measures, e-distribution of outcomes, information access for clinical decision making and statistical summaries and compilations. APRNs may also interface with financial technologies involving medical necessity, authorization, scheduling, billing, and image retrieval.
Although nurses with all types of preparation may practice within ACOs, the Advanced Practice Registered Nurses (APRNs), who provide care as physician extenders, deliver value to ACOs only if they learn to use the required technologies. Equally critical is removing some of the barriers that may prevent some APRNs from achieving full ACO participation. Whether ACOs survive and succeed in their current form or evolve in scope, direction, process, people and technology, APRNS can make an indispensable contribution in the quest for more accountable, value-based care and cost containment.