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In our last blog, "The Resurgence of the Small Practice," we discussed several evolving capabilities that will enhance the ability of clinicians in small practices to both drive and demonstrate value in the management of their patients. In today’s blog we examine more closely the role of interoperability in driving value for not just small practices, but for everyone in the healthcare ecosystem—including and especially patients.

Interoperability has become quite the buzzword. In fact, a Google search for “Interoperability in Healthcare” yielded 28 million results. Given its pervasiveness, it’s not surprising that the precise meaning of the term is often obscured. The 21st Century Cures Act defined three key components of interoperability: "(A)… the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user; (B) … complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and (C) [technology that] does not constitute information blocking as defined in section 3022(a).”

To understand what all of this means in practice, consider use cases in three arenas: clinical, social services, and administrative. 

1—Better care in clinical settings 

When a patient is receiving services from a provider, interoperability means that all relevant information is readily available at the point of service to both the patient and the provider. In an ideal world that means that no matter where other services were received the provider has all past history, diagnostic tests, treatments, and even social determinants of health (SDOH) at their fingertips. Similarly, for both staff and patients, appropriate information is readily available as needed. 

2—Coordination of healthcare and social services is enhanced 

Our most vulnerable populations generally face an alphabet soup of service organizations that support their housing, transportation, educational, financial, and other social needs. The impact of these issues on health outcomes cannot be overemphasized. It is estimated that over 80% of health outcomes are driven by socio-economic and behavioral factors. Interoperability among social service organizations as well as between social services and healthcare services will be critical to reducing health disparities across our communities. With appropriate information available no matter where, how, or when an individual seeks assistance, we could truly achieve a vision of “no wrong door”—seamlessly matching services to each person’s needs. This may sound like a pipe dream, but efforts are ongoing in communities across the country to create these linkages, and many health information exchanges (HIEs) are driving the flow of information across the landscape of healthcare and social services. 

3—Driving efficiency in administrative functions 

A study published in Academic Medicine in 2017 revealed that physicians were spending 24% of their working hours on administrative tasks. Often these tasks relate to requirements for specific information from regulators and insurance companies. The burden of supplying clinical justification for prior authorizations is a relevant example. In a fully interoperable environment, that clinical information would be available to the payer without the need to fill out forms or make phone calls. Many of today’s manual administrative processes could be fully automated. This would not only drive waste from the system but expedite the care of patients by reducing information-flow delays. 

Foundation for success 

Interoperability by itself will not solve the lack of coordination and cohesion in our current healthcare system. There are other critical gaps in healthcare infrastructure such as a lack of transparency and the primitive nature of current quality measures. That said, achieving true interoperability will be a critical and foundational component of success in our collective efforts to achieve improved outcomes for patients and communities, reduced cost trends, and improved provider morale.   

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Dr Lustick

Dr. Martin Lustick

Senior Vice President, NextGen Advisors

Dr. Martin Lustick is a principal and senior vice president with NextGen Healthcare focused on supporting provider organizations in their successful transition from volume to value-based care.

Dr. Lustick earned a BA in History from Cornell and an MD from Columbia. After completing his pediatric residency at Children’s Hospital National Medical Center in Washington, DC, he was in clinical practice for 17 years with Kaiser Permanente of the Mid-Atlantic States. While there, Dr. Lustick held various management and leadership roles, including chief operating officer for the 800-physician medical group. He oversaw development of their hospitalist program, population health capability, and open access delivery model.

Dr. Lustick then served as chief medical officer for ThompsonHealth—a small health system in Canandaigua, NY—where he provided clinical oversight for hospital, SNF, nursing home, IT, and out-patient physician practices.

In 2005, Dr. Lustick assumed the role of SVP & CMO for Excellus BCBS which covers 1.6 million lives comprised of Medicare, Commercial, and Medicaid. In his 13+ year tenure there he led a variety of strategic initiatives, including a patient-centered medical home program which served as the foundation for the plan’s value-based payment strategy. He also led the implementation of an automated authorization program for care management services, development of a clinical quality improvement strategy, and creation of innovative programs in management of low back pain, screening and prevention, opioid addiction, and chronic disease management.

Dr. Lustick has also been very active in the community, serving on boards and committees confronting issues such as: healthcare capacity planning, Health Information Exchange, mental health, substance use disorders, social determinants of health, and childhood obesity.