While the current shift to value-based care is undeniable, many healthcare executives are still uncertain what it means for their organizations specifically, and how they can prepare.
At industry events such as the CHIME Fall CIO Forum, as well as during meetings and direct conversations with CIOs, we are consistently hearing that the pressure to shift from a fee-for-service to a value-based care model continues to increase. The path to get there, however, is far from clear. Here are some of the key takeaways from our discussions with healthcare leaders.
• The endpoint is unclear. Perhaps the most surprising is that as a group, CIOs cannot pinpoint a time when the industry, or their organizations, will have “arrived” at value-based care. They are making progress, but that’s different than having an end in sight. This is an area, however, where CIOs also believe they can make a difference by working with fellow leaders to define what the end goal is and how to know when it has been achieved.
• Empowering clinical leadership as owners of the process is essential. Clinical and IT teams must work closely together and share ownership of value-based care if it is to succeed. Currently, many CIOs believe no one really “owns” the process. At the same time, data governance continues to be a challenge. Healthcare organizations must find intelligent ways of making the data available to those who need it for value-based initiatives while still protecting patient privacy.
• Enough with the buzzwords. CIOs are tired of hearing about “digital health,” “population health,” and other common buzzwords because every vendor, organization, and department seems to have their own definitions of what those initiatives entail. To be successful, leadership must define exactly what they mean and how they will measure success. Otherwise, the uncertainty will only increase and organizations will struggle even more to achieve the transition.
• Understand what you have—and what’s available. As organizations assess their current state, they must prioritize the measures they must track and report against, understand the data points they should be collecting to do so, and know the dollar value of successfully meeting those measures. They must also ensure they understand not only their current contracts, but what other options are available to them.
• The way data is gathered and used must change. CIOs noted that when electronic health records (EHRs) were first implemented, the assumption was that they would be the answer to value-based care data needs. That has not proven true, especially since nearly all EHRs were developed to meet the requirements of a fee-for-service model, in which they were data generators rather than data aggregators. To be effective, value-based care requires more than clinical data. Organizations need to incorporate claims, demographic, socioeconomic, social determinants of health, and other data into their analytics to understand their populations better so they can address care gaps more effectively and shift their focus from treating the sick to maintaining the health of their patients.
• The organizational structure must change too. There are significant organizational changes, such as care management and staff reorganization challenges, that must occur in sync with IT requests and demands. In some cases, current personnel may need to re-apply for their positions to ensure they have the skillsets required for the changing landscape.
• Telehealth is growing in importance—and acceptance. In a recent CIO focus group moderated by CTG, 89 percent of the participants said their organizations offer some form of telehealth services. As the technology improves and care management needs increase, the use of telehealth or remote health monitoring is likely to increase as well, assuming current reimbursement limitations are overcome. CIOs must ensure their IT infrastructures are prepared to handle this influx of data—especially video calls, which can strain bandwidth limitations.
• M&A shows no signs of slowing. Consolidation has many effects on CIOs, not the least of which is their employment status; after the merger or acquisition is completed, there is only room for one CIO. Beyond that, in the CTG focus group, 60 percent of CIOs whose organizations had been through the process said it either did not achieve what was intended or they didn’t know what had been accomplished. While it is generally believed that M&A will lead to greater efficiency, the reality is that, in most cases, it only brings additional patient volume. Involving IT early in the due diligence process, and following a standardized playbook, can help the organization gain more value faster.
Making a difference
While the outlook may be concerning at times, the good news is this uncertainty creates an opportunity for CIOs to provide much-needed leadership in the transition to value-based care—not just from an IT perspective, but from a clinical/organizational perspective as well.