In his keynote address Monday, Feb. 24, at HIMSS 2014, Aetna CEO Mark T. Bertolini declared “It’s the perfect time to change.”  He makes the case for three key priorities for the country’s ailing healthcare system.

  1. Invest in helping individuals take steps towards improved wellness via healthy choices and lifestyle
  2. Improve the care of the chronically ill
  3. Align financial incentives

As I walked up and down every aisle in the HIMSS exhibit hall, I was acutely struck by an overwhelming observation that I didn’t appreciate until I started focusing on the HIT needs in the health and human service space. There is a misalignment between Mr. Bertolini’s prescription to create a better healthcare system and where all the focus, attention and frankly, investment lies, as reflected by the exhibition hall and education sessions at HIMSS.

Mr. Bertolini was calling out payment reform when he called out priority #3. His prescription for aligning incentives is directed at care providers and moving away from volume-based revenue incentives. Care needs to be more efficient and more effective, delivered by the lowest possible cost setting. The financial incentives for HIT and related services seem to be similarly focused on the most expensive setting of care. As I was walking around the exhibition hall, I was overwhelmed by the level of investment, product and services specifically tailored for the most expensive venue of care. The sheer number of vendors, products, gadgets and displays trying to win placement in every nook and cranny of acute care hospitals is staggering. The HIT market is a significant slice of a still very large pie that isn’t shrinking. As long as acute care remains costly and continues to grow, the HIT market grows proportionately. I get it; the vendors get it. The ARRA stimulus package added to the financial incentive. Did we inadvertently create the same moral financial hazard with misalignment as exists with medical insurance?  And, are we missing the bigger picture?

Prescription #2 recognizes the development of chronic conditions ultimately drives a large proportion of the healthcare cost, negative impacting population productivity, stress and satisfaction. Yet, one of the most difficult and most costly cluster of individuals with chronic conditions are those with both physical and mental co-morbidities.

Across the exhibition hall and education sessions, the demonstration and case vignettes related to behavioral health were almost non-existent, except in a few isolated cases.  There is a lack of representation and HIT focus to automate the care process related to the care of those with behavioral health needs. HMSS is a reflection or barometer of broader market sentiment, priority and focus.  Mr. Bertolini’s prescription must be expounded further to call-out, heighten awareness, focus and efforts across the care provider community as well as HIT partners for the needs of some of our most challenging population. To achieve a better healthcare system, it’s required.