Adopt Strategies for Value-Based Care and Long-Term Sustainability in Post-Pandemic World
By Josh Hetler
In today’s challenging healthcare environment, hospitals, health systems, and providers that want to remain sustainable are securing their financial footing by moving toward value-based models and embracing technologies that provide the most efficient high-touch care.
Tapping into operational efficiencies and adopting an innovative interoperability solution can help organizations hit the ground running post-pandemic to meet the needs of increasingly data-oriented, value-based reimbursement business models. In this evolving healthcare ecosystem, many now recognize the importance of effective interoperability of electronic health records (EHR) and the ability to improve patient care and safety, enhance patient-centeredness and communication, and advance programs related to education, timeliness, efficiency, and equity.
Effective interoperability also enables healthcare professionals to promote preventive medicine initiatives and better coordinate care, as well as reduce waste and redundant testing. This is important, given how the COVID-19 pandemic has provided a stark reminder of the digital divide that remains across the U.S. healthcare system.
While current federal rules require providers and payers to free patient data from behind their organizational walls for use with patient apps and broader data sharing, only 24% of providers and health plan executives surveyed view this as an opportunity, while only 44% said their organizations went into 2021 with a solid interoperability plan in place.
Healthcare leaders should view interoperability not simply as a compliance issue, but more so as an opportunity to create long-term sustainability and enterprisewide resilience while building strategies for growth post-pandemic in a way that will absorb future shocks. This means gaining robust interoperability capabilities to meet the shift toward a safer, more patient-centric, value-based healthcare system. When patients are empowered to make better choices related to their health, the investment in interoperability solutions can lead to lower costs, improved quality of care, and better patient engagement.
Challenges to patient safety
A study exploring how poor health IT interoperability can impede safety and care quality—and lead to unintended consequences—highlights these challenges:
- Health information exchange (HIE)—Incomplete, inaccurate, or untimely exchange of data can result in patient matching problems, quality issues, integrity loss during transmission, and technical limitations.
- Data presentation and overload—Many EHRs are not optimized to manage HIEs’ massive amounts of data, leaving clinicians unsure about what data to present or whether information is missing from the HIE system. This negatively impacts clinicians’ workflow and their ability to use HIE information to provide and coordinate care.
- Semantic interoperability—Without the ability for HIEs and interoperable health devices to transmit data within its original context, providers cannot understand the original context in which the data was collected and used—which is critical for future care encounters with patients.
Other HIE usability issues can leave providers questioning data’s accuracy and reliability. Also, when health devices are not interoperable—such as EHRs, infusion pumps, and pulse oximeters, to name a few—they can create a significant added burden on healthcare professionals.
Focus on value-based care
Value-based care models rely on vast amounts of patient information to be collected and organized in a meaningful way between systems, all of which must be standardized. Synthesizing this data will allow for more guided care that also addresses social determinants of health (SDoH), socioeconomic factors that inform more proactive “upstream” healthcare to prevent health problems from developing.
About 30% of healthcare resources are wasted, but when records and data are properly organized and able to be analyzed, providers can identify areas that need more financial support, and areas that might involve wasteful spending. In turn, this helps providers create a better and more efficient system designed to deliver honest and useful healthcare to its patients, as well as financial accessibility for the providers.
Value-based care relies on EHR systems becoming interoperable. When health information and interoperability solutions are designed to deliver a personalized and integrated experience to patients, they have the potential to increase provider productivity, better engage caregivers, improve outcomes, and enhance affordability.
New technologies also have the potential to foster care that can be delivered in any setting, including the home, to support continuity of care and curb rampant healthcare costs, which is especially critical for chronic conditions.
Innovative solutions offering integrated population health applications, interoperability, provider engagement, and value-based care performance management can expand clinical data integration, advanced analytics, and financial informatics capabilities.
Value-based risk analytics, quality measures management, risk scoring, and financials in a single-source, cloud-based platform represent the wave of the future for many healthcare organizations. But it’s important to combine these capabilities with advanced clinical connectivity that is designed to help payers and providers close gaps in care, recapture Hierarchical Condition Category (HCC) codes, and manage utilization to reduce the cost of care.
Optimizing quality and interoperability
Value-based care enablement solutions have emerged to help hospitals and health systems to effectively empower providers to identify open care gaps for proactive closure and provide payer-agnostic data to inform clinical, quality, and risk adjustment programs for improvements in quality and risk adjustment scores and patient outcomes. This type of comprehensive solution should be designed for payers, providers, managed service organizations (MSO), accountable care organizations (ACO), and provider groups that manage quality, risk adjustment, and care for patient populations.
The solution should be meaningful use certified and offer a robust Healthcare Effectiveness Data and Information Set (HEDIS) engine that is National Committee for Quality Assurance (NCQA)-certified for all measures and refreshed annually for the most accurate data. This level of capability facilitates the transition to value-based care by meeting the need for a complete interoperable population health management solution that aligns the payer, provider, and patient with one view.
Look for a value-based care enablement solution that offers real-time data insights captured from disparate sources, allowing 360-degree visibility into the patient’s health status based on information from EHRs, HIEs, claims, labs, pharmacy, and hospital sources. Through the aggregation of data from these sources, users gain real-time data transparency and patient-level drill-down dashboards. It should also provide improved workflow and collaboration opportunities to break down departmental silos across the organization.
The key to value-based care is to tap into meaningful data and technology applications to efficiently manage patient-centric care that results in improved outcomes and lower costs. Optimized interoperability enables healthcare organizations to leverage data, better manage their providers, improve performance, and deliver better patient care and outcomes.
Data connectivity between EHRs and payers
Choose an interoperability solution that offers the connectivity of data sources and bidirectional data feeds between systems, and that extracts continuity of care document (CCD) data. This allows providers to receive real-time insights while the patient is in the office. Powered by FHIR-enabled API standards, EHR connectivity and seamless data exchange are enabled at the point of care.
Organizations that embrace innovative interoperability approaches versus more traditional healthcare organizations will be better positioned to earn patient trust by integrating the data and providing innovative products and services. Those who fail to make this transition risk being left behind.
Going forward, fully interoperable digital health records will serve as the backbone of value-based care by enabling healthcare providers to share data, measure outcomes, improve (and be rewarded for) quality care, and promote accountability to patients.
Josh Hetler is executive vice president of business intelligence at DataLink.