Healthcare organizations that are participating in value-based care arrangements through government and private payer contracts and as accountable care organizations have long known that using technology and data to improve care is key to success. But getting there hasn’t been easy.
Value-based care — a model that ties reimbursement payments to the quality of care a healthcare organization provides — rewards organizations for keeping populations of patients healthy. An alternative to fee-for-service reimbursement, which pays providers based on how many patients they treat, successful value-based care programs aim to improve quality and patient experience while reducing costs and focusing on prevention and population health.
The concept goes back to the often-maligned HMO movement, but it got a makeover in the rollout of the Affordable Care Act: The Centers for Medicare & Medicaid Services, or CMS, has been pushing it ever since. But many healthcare organizations are still struggling to either get up to speed or keep up their momentum.
In a study by Quest Diagnostics reported this summer, physicians and health plan executives agreed healthcare has made little progress toward value-based care since last year: More than two-thirds (67 percent) of physicians and health plan executives said the U.S. still has a fee-for-service system. And only 39 percent of physicians said electronic health records provide all the data they need to care for their patients, according to the study.
“We talk about value-based care, but for the life of me it still looks like we’re still doing pay-for-volume,” says Charles Christian, vice president of technology and engagement at the Indiana Health Information Exchange. “There is this chasm between volume-based reimbursement and value-based reimbursement that we have to figure out how to jump. I haven’t seen a good roadmap to how we’re going to get to paying for quality.”
How Data Can Support — and Stymie — Value-Based Care Efforts
One of the difficulties of participating in value-based care programs, as physicians in the Quest survey noted, is having the right data to not only support efforts to provide high-quality care to patients but also to measure and report quality results to CMS and other payers.
Atrius Health, which is made up of 32 physician practices with more than 800 doctors across Massachusetts, participates in CMS’ Next Generation ACO model, in-state Medicaid ACO and has risk-based contracts with private payers, each with their own quality measures and quality reporting requirements.
“One of the challenges of quality reporting is just how many metrics there are across different quality requirements,” says Craig Monsen, chief medical information officer of the nonprofit organization. “It can feel sometimes like the quality metrics are a distraction from what I went into medicine for — which is to help people, not report on them.”
Atrius takes advantage of the fact that value-based contracts usually include a menu of quality measures that best align with its patients’ needs and its own priorities from year to year, Monsen says.
“Part of it is just identifying our priorities. Part of it is, once we’ve identified our priorities and the metrics we are looking to drive, we have the challenge then of extracting that information,” he says. “We definitely benefit from our technology,” he adds, including its Epic EHR and the Linguamatics natural language processing tool.
Another challenge to implementing value-based care and reporting quality measures is that, even as healthcare organizations have become more adept at gathering and using data, the volume of it continues to grow at an overwhelming pace, Christian says.
“We’ve gotten better at being able to deal with coded data to enhance the care process but also to help manage populations. But it’s gotten a whole lot more difficult to manage, I think.”
How Technology and Data Can Power Value-Based Care Efforts
Managing that data by optimizing EHRs, making data more accessible and insightful and reducing the complexity of quality measurement reporting are critical to accelerate the transition to value-based care, Dr. L. Patrick James, chief clinical officer of health plans and policy at Quest Diagnostics, said in a statement.
“First, however, it's clear that health plan executives and physicians need to better align around a shared vision of how technology and data can improve patient care," he said.
Indeed, there’s opportunity at the intersection of technology, workflow and people, Monsen says. The key is to “figure out that interface of technology workflow or processes and people’s roles and responsibilities to deliver what we’re driving toward, which is better patient care,” he says.
“Value-based care is an evolving concept for healthcare providers,” adds Shruthi Parakkal, a transformational health consultant at Frost & Sullivan, which is headquartered in San Antonio, Texas. “Healthcare authorities should not lose sight when finding key performance indicators for a pay-for-performance-model that, while it can be metric-driven, they should be able to account for non-cost-related metrics, such as patient satisfaction and physician efficiency.”
Technology and data that engage patients can help organizations keep up with the demand of caring for populations of patients, she says.
“Digital health will play a major role in clinical decision support and for evidence-based care delivery — and this will help to measure value beyond cost and efficiency,” Parakkal says. “To improve quality of care and achieve cost efficiency, care coordination and patient engagement is critical. Patients will have an increasing role to play in self-management, wellness and prevention, chronic disease management, follow-up and monitoring. For this, they will have to be engaged by hospitals beyond the basic patient portal to offer communication with physicians.”
How to Engage Patients with Their Own Health
Beyond-the-basics digital health tools to aid engagement and communication include wearables, apps and at-home medical devices that can send and receive data to and from providers; telehealth and remote consultations; and patient awareness tools such as wellness apps and online platforms that educate patients about their health conditions. Even online scheduling can help, Parakkal says.
“In the long term, an integrated healthcare ecosystem that connects patient-generated data to hospital-generated data will be critical,” Parakkal notes.
Emerging value-based care technology trends include artificial intelligence, machine learning and Big Data. But it’s not which technology healthcare organizations use to engage patients and improve outcomes, according to Parakkal: It’s how organizations deploy those tools.
“For providers to offer maximum value to patients, clinical decision support will be critical. For patients to be an integral part of the value equation, self-management is critical. Data sharing securely is also critical,” she says.
“There is a huge hype over technology or only digital health taking over the care delivery. I personally believe it will be man and machine that will generate maximum value,” she says. “Digital health will increasingly play a role of healthcare augmentation — supporting physicians to deliver the best outcomes.”