4 strategies to successfully use data to transition from volume to value

The core challenge in establishing a more sustainable healthcare system is that the current model evolved in a way that made curbing costs increasingly difficult.

The traditional fee-for-service system relied upon cost sharing with the patient to curtail medical costs. Providers were incentivized to use more tests and procedures, and there was no financial downside to the patient for doing so. This created an intrinsically flawed healthcare system, one that needed fundamental restructuring.

In one of their most ambitious initiatives ever, the federal government has orchestrated a new healthcare system — one where payment and success are tied to value rather than volume.

This move has left some healthcare administrators scrambling to find the best way to appeal to consumers and deliver the high-quality care necessary in the new market. But it's the administrators, who understand the importance of effective data collection, who already know: The formula for success lies within each organization.

The changing healthcare landscape

The Oct. 14 release of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule marks the official transition from a fee-for-service healthcare system to one based on improved quality and value.

Under MACRA, new payment structures — including the Merit-Based Incentive Payment System (MIPS) and Advanced Payment Models — will, in part, use data to score the quality of care delivered by providers within the Medicare regime. For example, under MIPS, composite performance scores from 0 to 100 based on four different categories will be assigned to providers to determine reimbursement adjustment rates.

Providers who fail to meet these performance thresholds should expect lower or limited payments from the Medicare program. But chronically poor performers could face long-term consequences. Because physician scores will be available to the public, patients can use those ratings to shop around for the best doctor, not just the most convenient option. Physicians with negative patient feedback and low ratings could see a significant drop in business as they're repeatedly passed over for higher-quality care providers.

Providers who put systems into place now to quantify and optimize the quality and value of their services will be able to transition their organizations without significant setbacks or disruptions to business. In fact, with thoughtful planning, newly established financial incentives may be realized.

Getting ahead with data-driven care

It is important to note that data can be used for much more than grading providers' performances. Healthcare providers can collect and analyze their own data to enhance their patients' experience and benchmark progress against others similarly situated.

As the pillar of evidence-based medicine, collecting data is the fastest way to learn about an organization's strengths and weaknesses. This is especially beneficial in areas that affect patient safety and health or drive up costs. Through the analysis of patient health data, a provider can set health improvement goals, meet industry benchmarks for quality of care, evaluate the effectiveness of special programs, and identify issues surrounding reimbursement for services.

Data can also help patients and healthcare professionals minimize healthcare-associated infection (HAI) rates, especially surrounding surgeries. With one recent survey identifying as many as 722,000 HAI cases and roughly 75,000 HAI deaths during hospitalization in the U.S. during 2011 alone, it's clear HAIs are a prominent and serious threat to patient safety. However, research has shown that identifying problem areas and taking measures to prevent or correct them — both of which can easily be done through data collection and analysis — can reduce the risk of HAIs by as much as 70 percent.

Finally, data has been shown to benefit patients through enhanced educational measures. Dr. Karen DeSalvo, the assistant secretary of the HHS, explained that offering patients access to their health data not only improves patient engagement, but it also empowers them to take more control of their health. This is particularly important for high-risk patients, like those with chronic health conditions or those who struggle to adhere to treatment plans. But all patients will benefit from improved provider-patient collaboration and an enhanced patient-centric healthcare system.

Working within the new system

It will take a few years for the entire industry to shift to the value-based care system. But providers can begin delivering these benefits — and so much more — to their patients sooner by establishing their organization's data collection plan. Providers can make the greatest impact by:

1. Using data to create a complete picture of patients: Patient outcomes and clinical data collected over the entire episode of care will provide invaluable insights regarding each patient's complete healthcare experience. This information can be used to understand how to best serve each unique demographic of patients, as well as what can be done to make each experience better.

Using validated forms that meet an institution's specific needs, establish data collection points that capture every piece of vital information — like patient demographics, health history, episodes of care, outcomes, satisfaction, and costs associated with care.

2. Using a QCDR for reporting outcomes data: Data registries can yield rich data sets for retrospective mining to support research needs. They're especially helpful when evaluating the effectiveness of various treatments, medicines, and practices for specific diseases — and within specialties of care. Qualified clinical data registries (QCDRs) also simplify the process of compiling and reporting data to CMS and non-CMS specialty organizations.

First, determine if patients and providers would benefit from a QCDR. Then research options to find the best fit and value for the organization.

3. Finding meaningful insights within a practice's quality measurement tools: Thoughtfully selecting the quality measurement tools that closely complement an organization can provide with a host of meaningful insights and offer unique opportunities to push an organization toward greater success. For example, if infection rates are found to be high, a provider can concentrate on improving conditions that might be increasing these incidences. Or if high readmission rates are a problem, it could present an opportunity to educate patients — both in clinic and at home following release — on actions and behaviors that will reduce complications after surgery.

Compile and analyze data to identify problem areas within an organization or care practices. Then assemble a team to brainstorm practical ways to overcome these obstacles and enhance the care an organization provides.

4. Diversifying the outcomes used: Selecting outcomes that have garnered consensus can allow a provider to leverage the maximum opportunities for benchmarking and population health research. Stay alert for emerging developments in the outcomes measurement area. Look for opportunities to develop new measures, including appropriate use of patient-defined outcomes.

As the healthcare industry shifts from a fee-for-service care system to one based on quality and value, don't forfeit control over an organization's future and success. Instead, take measures now to establish a data-collection program that will guide staff, strengthen your care practices, and provide patients with the highest quality care available.

Andrew Clement is the director of operations at OBERD. As a former Registered Nurse, Andrew helps guide OBERD to ensure it delivers patient-centric products and services to its customers. Patient-Reported Outcomes data collection is core to OBERD's patented software solution. Andrew works with a multi-specialty team to provide healthcare systems with the innovative data solutions they will need in the future as the industry transitions toward value-based care.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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