Even as the future of the Affordable Care Act remains uncertain, one thing is clear: value-based care remains a priority.
Healthcare payers continue to implement value-based reimbursement models, such as risk-adjusted and quality-based reimbursement, as well as global payments (bundles, capitation, etc.). The Healthcare Transformation Task Force estimated over 41 percent of reimbursement was value-based in some manner in 2015, up from only 30 percent in 2014.1 Although these models continue to face operational and conceptual challenges, movement away from straightforward fee-for-service is continuing and does not appear to be dependent on federal policies.
The message I'm hearing across the industry is, "Let's keep going!"
But we're still in the infancy of value-based care. The key to taking value-based care to the next level is data—specifically, leveraging the value of clinical and administrative data that exist in both payer and provider organizations. It demands payers, employers and providers to use the right tools—not only to integrate and analyze data, but also to share it in ways that are meaningful, providing physicians with actionable information to improve care.
For example, by collaborating with community groups such as youth groups and neighborhood associations, payers, employers and providers can access data that shed light on the social and behavioral determinants of health that impact individuals and populations. They can then use this data to proactively manage care and care coordination, such as by purchasing a refrigerator for a low-income chronic disease patient to keep medications cold. When delivered early in the progression of disease, non-traditional actions like this can prevent care from becoming more costly over time while improving health outcomes.
Data also are critical to improving efficiency and significantly reducing cost. For instance, in some accountable care organizations, as much as 55 percent of patients are going out of network for their care.2 We can use data to drill down to the individual patient or provider and have meaningful conversations with physicians around why bringing out-of-network care back into the network may be best for both the patient and the health system, particularly given our goals of improving care coordination.
Putting data into focus
Here are three strategies healthcare organizations, payers and employers can use to focus ahead on the journey to value-based care:
• Take advantage of the clinical data already available. Establishing data-sharing relationships with community organizations is critical to building out a more comprehensive view of the patient. So is seeking data from disparate sources, such as employee wellness programs, wearable devices, and dental and disability claims. Together, these actions will help in developing more nuanced approaches to care, improving outcomes while reducing costs.
Another way to gain access to clinical information is through state health information exchanges. By accessing health information exchange data, providers can determine whether patients who have not previously sought care from the organization have been treated elsewhere. Some electronic medical records (EMRs) and electronic health records (EHRs) also support the exchange of data with other organizations that use the same system. Shared-data approaches provide a more robust picture of a patient, improving care coordination and transitions of care while avoiding redundant—and costly—testing.
• Ensure data is actionable to a wide variety of stakeholders. Not everyone is a data analyst. Chief medical officers and other clinical professionals play a vital role in value-based care, whether by directing the work of clinical teams to better meet the health needs of specific groups or emphasizing the value of a population health management approach. Consider the way in which data is viewed as well as organized and look for ways to optimize data presentation and access so that a wide range of people and functions can use the data effectively.
• Ask more and better questions of your data. One of the biggest challenges providers, payers and employers face is separating out the noise from the actionable information. This is becoming a bigger problem as the volume of information grows. It is important to work with professionals who can help talk through the findings, pull out key insights and help determine next steps for improving value. Additionally, when you make a change based on the data you are seeing, know what questions to ask to determine whether the adjustment you've made has been successful. For example, healthcare organizations that introduce a new patient discharge plan should know which five measures they will use to determine whether the program has made the desired impact.
As the move toward value-based care progresses, it is no longer good enough to just use data to look retrospectively at how we have performed. We also need to use data to predict the impact we will make in the future. The ability to effectively leverage clinical data will be an organization's key asset in the continued journey toward value, providing actionable intelligence that improves health, coordination of care and outcomes — today and in the future.
1 http://hcttf.org/releases/2016/4/12/healthcare-transformation-task-force-reports-increase-in-value-based-payments
2 http://e-caremanagement.com/patient-leakage-rethinking-two-field-of-dreams-assumptions-about-acos/
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