Healthcare has been slowly but surely shifting from fee-for-service reimbursement models toward value-based care. In 2015, HHS announced a goal of having 50 percent of Medicare payments tied to quality or value through alternative payment models. While movement has been made toward that goal, we are not there yet.
"Today, there are any number of forces driving changes in healthcare," said Michael Blackman, MD, medical director of population health and analytics at Allscripts, during an Aug. 21 webinar sponsored by Allscripts and hosted by Becker's Hospital Review. "These are both exciting and challenging times … everyone is being asked to do more with less."
Some of the forces driving change in healthcare include the rise of consumerism, clinician burnout, reimbursement changes and the increasing popularity of personalized medicine. Additionally, per capita healthcare costs in the U.S. are still a great deal higher than any other developed country, without stark differences in quality, Dr. Blackman said.
However, we still don't know exactly what value-based care will look like. Dr. Blackman relayed an apt metaphor for the transition to value-based care: It is like having one foot on the dock, one on the boat and trying not to get wet as the boat moves away.
But we do know that value-based care is good for patients, clinicians and, ultimately, for the organizations. Delivering patients more coordinated and cost-effective care will necessitate more organized and intuitive workflows for physicians, which will then improve quality and reduce cost for the healthcare organization.
"If we do what is best for the patients and clinicians, it will create value for the organizations," said Dr. Blackman. "And conversely improving the organization and the work environment improves employee satisfaction and people who are happy at work are more likely to be engaging with patients. It's a completely circular event."
While value-based care holds great promise for patients and clinicians, hospitals and health systems must overcome a number of challenges to make the transition away from fee-for-service successful. These challenges include meeting new regulatory requirements, addressing clinician burnout and incorporating new workflows designed to meet healthcare's changing needs.
Unlock the promise of value-based care with data harmonization
Data locked in silos has very limited value, and so data harmonization and naturalization are key to truly unlocking the promise of value-based care.
Data comes from various sources, including EHRs, claims, laboratories, devices and public health databases. Information is collected using different coding schemata and cannot be effectively leveraged until it is harmonized and patient-matched. Data harmonization creates a foundation for achieving true process interoperability across the enterprise, which is one of the keys to successfully transitioning to value-based care.
Once the data is harmonized, clinicians can mine it for the information they need to improve outcomes. Value-based care involves getting the right information to the right people at the right point of care.
"We used to joke that in the EHR we had lots of data, but no information," Dr. Blackman said.
Thus, organizations should consider implementing a robust analytics platform that can be used to leverage the harmonized data and glean key information, which can then be given to the care team.
The new information can give clinicians answers they couldn't get before as well as the opportunity to ask more pressing questions. Rather than asking patients to repeat information, they can come to the patient with information they have and ask them to expand on it. Additionally, comprehensive patient records help reduce unnecessary testing.
Adding community information to a patient’s medical record can also help clinicians gain a deeper understanding of a patient's condition. Having easy access to information about lab tests and previous care visits documented in the EHR helps clinicians ensure safe and effective patient care.
Keys to success under value-based care
The transition to value-based care may not always be smooth, but it is worth it.
"Value-based care requires change and frankly that change is very hard work," Dr. Blackman said. "We need to remind people of the advantages to the patient, the provider, the organization and to themselves."
Here are four keys for success:
1. Keep in mind the difference between document exchange and true data exchange, which is better as you can bring usable information to the point of care.
2. Ensure direct access to a complete, 360-degree view of patient information that can be used to confirm and change decisions and reduce repetitive testing.
3. Increase touches with the patient across the continuum of care whether that's automated or in person.
4. Remember IT plays a critical but only a supportive role – value-based care initiatives are clinical projects.
Upfront investment and willingness to commit to change are necessary for the transition to value-based care, Dr. Blackman said.
To learn more about Allscripts, click here, and view the full webinar here.