Monday, July 21, 2014
The IBM Center for the Business of Government enhances its capacity to provide thought leadership about effective and efficient management of health-related programs in government

In light of the ever-increasing demand for health care services due to demographic shifts, technology innovations, and consumer expectations, government plays a critical role in delivering services to a diverse population through a wide range of health-related programs. The imperatives to develop and operate these programs effectively and efficiently require approaches and solutions that leverage the best approaches to managing amidst complexity across the private and public sectors, adapted for the unique nature of a national health enterprise in which government works with providers, insurers, and others around programs that touch nearly every American.

With growing complexity comes a need to increase attention on what works for government to produce better outcomes at a reasonable cost.  This theme has been at the core of many areas addressed by the IBM Center for the Business of Government over the past 15 years; in thinking through how best to apply best practices and lessons learned in the health enterprise, we are elevating the focus on this issue within our portfolio.  Accordingly, we have created a new position in the Center of Health Fellow.

We are very pleased to announce that Dr. Keith Salzman will serve in this new role.  Dr. Salzman, who already serves as Chief Medical Information Officer in IBM's Federal business, brings a wealth of experience and expertise from government, industry, and practice to help frame issues and identify alternative paths forward that can enhance how government provides health services, including more than two decades of experience in delivering quality care to patients and driving the use of medical informatics within the U.S. Department of Defense Military Health System. Earlier this year, Dr. Salzman received the 2013 Physician IT Leadership Award from the Healthcare Information and Management Systems Society, a global network of health IT professionals.

Dr. Salzman's blog will appear regularly on the Center's page, and with this announcement we are pleased to share his first submission.  Please join us in welcoming Dr. Salzman to the Center!



Improving Performance in Government Health Care

By Dr. Keith Salzman
Health Fellow
IBM Center for The Business of Government


US Healthcare is approaching the tipping point for accelerated transformation. With the HITECH Act, Affordable Care Act and American Recovery and Reinvestment and Act, the investment in healthcare transformation has received a significant nudge.

The Standards and Interoperability Framework led and funded by the Office of the National Coordinator provides a rich process to develop use cases which are now being piloted to validate standards for use in moving information within the healthcare ecosystem. These products will enable digital information exchange and the tools to realize the promise of interoperability.

As interoperability is established and extends to a comprehensive view of patient care, the next step of transformation, integrated care will become commonplace. There are relatively closed systems now that provide integrated care and demonstrate cost savings as well as improved outcomes and are discussed in Clay Christensen’s book, The Innovator’s Prescription, and demonstrated in organizations like Aetna under Mark Bertolini.

Personal Health Records move the possession of healthcare information to the patient and offer the opportunity to aggregate disparate information from various organizations at a repository controlled by the patient. As a result, patients as consumers can help drive interoperability by demand and are empowered to become more engaged in their healthcare.

One of the critical factors that will move the transformation of the healthcare industry from the initial efforts of early adopters to general acceptance is payment reform. The existing model of fee for service perpetuates retention of information rather than sharing and interoperability. Shifting payment for care to an outcomes based model will reward practices that take a more comprehensive view of the patient.

While there many other components in the transformation of the healthcare industry, these are among the top prime movers.

All of these issues have significant impacts for government leaders in the health care field in terms of how they frame and manage programs most effectively.  Over the coming months, through this blog and other activities that I will pursue as the Health Fellow with the IBM Center for the Business of Government, I hope to examine and suggest ways that government and partners in the Federal health system can best leverage the rapidly changing health landscape to improve performance -- for example, taking working examples of integrated care and offering them to use in the broader community in the healthcare ecosystem.  I look forward to engaging in a dialogue that will help the community of stakeholders manage effectively and efficiently in this critical area where government services citizens.