Broadly speaking, value-based care is defined by partnerships and collaboration between various stakeholders in a given market where insurance risk is shared. Stakeholders include provider systems, large physician groups and health plans.
The many facets of value-based care continue to be talked about among health system CIOs. If a health system is consid- ering whether value-based care may be in its future, CIOs and the rest of the executive team need to ask some hard questions of executive peers, IT and other internal stakeholders such as:
- Should we pursue value-based care? Perform a market economic survey to make sure the market will reward you for the significant amount of investment. There are efficient markets that have seen minimal cost growth over the last few years. They have already begun reaping the benefits of collaboration across different health plans and providers without requiring new financing mechanisms or financial incentives for providers to manage resource utilization.
- Is the organization ready for value-based care? Implementing value-based care requires commitment from many resources in the organization. It is not a part-time, off-the-side-of-the-desk job but rather a full-time job that requires a fundamental reordering of investment priorities and resources.
- What does IT need to do to empower value-based care? Analytics and reporting need to be embedded in executive and clinical decision making with up-to-date data and specific audiences in mind. When I say analytics, I'm not referring to predictive analytics, artificial intelligence or block chain. I'm referring to foundational data such as encounter and transactional data. Once you do that, you can begin to migrate toward driving population health design and care management changes.
It's all about that data
EHR data has a life beyond the transaction, data entry and decision support roles that get charted within the EHR workflow. Getting data out of the transactional EHR system and into an analytical system is no small task. Determine whether the EHR is feeding data and analytical warehouses in such a way that a data model allows for basic population health analytics. Make sure you have tools to report on the data.
Eventually, you're going to want to look at data from performance analytics to answer more sophisticated questions. You can ask the basic question, how many diabetics? How many inpatient days last year, last month, or last quarter were associated with patients who had the primary diagnosis of diabetes? And how did that change year over year?
It comes down to how robust your analytic infrastructure is. Have you built a layer within your EHR and your systems that can combine those data sets effectively and provide you some insight into longitudinal care patterns?
You've already got some data
It's important to know the populations you serve. Take inventory of what data you can access immediately or data you can access simply. Basic claims or billing data can spotlight high-utilizers if organized correctly. If data is organized so you can stratify it based on utilization, map to a diagnosis-related group (DRG) or an ICD-10 code, you've generated significant potential insight without massive investment in data acquisition, data integration or report development.
Wanted: new skill sets
Do you have enough smart, creative, curious resources skilled enough to run those reports to manage the value-based care contracts? Can they identify gaps in care models or hot spotters in the community? Through no fault of their own, most health systems never had reason to build a skill set like that in either their IT or population health shops. However, in a value-based care world, that skill set is essential. Additionally, most analytical infrastructures in the country don't have the skills sets required to analyze all that data.
Five key takeaways
As the saying goes, you have to walk before you can run. If you begin the value-based care journey, consider the following:
- Focus on best practices and usefulness. For example, what to roll out and when. Set a strong foundation so when it's time to expand your value-based care program, you've planned for growth and can move toward that.
- Formulate strategies. Bundled payments, pay for perfor- mance, etc., are tactics of value-based care, not strategies. Create a short-term strategy but don't forget about long-term growth and expansion.
- Have a roadmap. How can the organization start to generate immediate value, even if it's short term, to give the momen- tum necessary to justify the investment in the next phase of data acquisition and integration?
- Know your population. As said before, know the population you serve and who and how you want to target them. EHR, claims and billing data can provide tremendous insights into your population.
- Report effectively on the data. A visually compelling report helps third-party stakeholders identify care gaps, highlight hot-spotters and other population health "flags."
What's next?
Once your value-based care program is running with data and analytics in place, you can move toward technologies like remote monitoring and telehealth to deploy to populations. A lot of investment is being made on building the next generation of analytical platforms that integrate clinical and claims data and provide predictive analytics. In next month's feature, we'll focus on the right level of IT spending to drive innovation at provider organizations.
To learn more about value-based care from our experts, visit www.optum.com/AdvisoryServices
About the author
Erik Johnson is a VP and Practice Lead within Optum Advisory Services, which specializes in helping health system, clinical and ambulatory leaders address their biggest challenges with the guidance, insights and precise strategies needed to help assert control over their organization’s future. He has experience in designing population health strategies for a broad array of providers. Erik assists healthcare systems in determining how to adopt and assess accountable care and bundled payment models, guiding overall strategy. Erik also worked with health IT companies in responding to emergent issues around EHRs and data exchange.