Value-based care is expected to account for 59 percent of healthcare payments by 2020, up from 34 percent in 2017, according to a recent Accenture analysis. The ongoing shift from fee-for-service to value-based care means hospitals and health systems need to better understand and anticipate the needs of the patients they serve.
As they take on more financial risk, reliable data-driven insights surrounding every aspect of care delivery -- quality, cost, utilization, variations in care, patient behaviors and patient outcomes -- are required.
But oftentimes providers' primary source of data comes from electronic health records, and EHRs can be an inadequate source for data-driven insights, according to a recent white paper from Geneia, which is the business of providing the technology and services needed for better collaboration and alignment.
To get a better handle on value-based care, better data strategies are needed.
The problem with EHRs, according to the paper, is that they're designed for fee-for-service, encounter-based medicine. They don't capture enough information to tell the whole story of individual patients or populations. They also don't make it easy to share data with everyone who needs it.
Traditional fee-for-service arrangements work whether clinicians understand the underlying cost drivers or not. As a result, EHRs rarely reflect margins, quality performance, engagement preferences and other related metrics. In contrast, successful population health strategies depend on everyone across the organization understanding their role in achieving quality, outcome, engagement and patient-satisfaction goals.
Today's world of isolated EHRs and Health Information Exchanges was not designed to handle collaborative patient care across care teams, especially care teams spanning multiple health systems. Hospitals and health systems hoping to achieve population health success need to look beyond their EHR to cloud-based solutions, Geneia found.
The same holds true for social determinants of health data. Data analytics rely heavily on EHR and claims data, but social determinants of health such as patient behaviors, environmental conditions and socioeconomic elements, account for 80 percent of factors that impact health outcomes.
To effectively capture SDoH data, Geneia recommends hospitals train frontline care teams and registration/admissions staff on better collecting more types of data during patient encounters. They should also work with EHR vendors and internal IT departments to augment and standardize their existing software across departments to properly record SDoH and other important data.
WHAT ELSE YOU SHOULD KNOW
Beyond the EHR, hospital leadership ready to invest in technologies to support collaborative care and population health strategies should expand the search to consider vendor-agnostic solutions. A vendor-neutral population health management solution, unaffiliated with any existing EHR vendor or data source, is free from inherent bias and able to gather data from all available sources without prejudice.
They are, more often than not, better equipped to normalize, match, enrich and translate data into an actionable and interoperable format for all their clients -- whether hospital, employer or payer-based.
An April Change Healthcare report examined state-run value-based care initiatives across the country, and singled out three states -- New York, Pennsylvania and Vermont -- for the broad scope of their initiatives, embracing payment models that involve shared risk, and willingness to test innovative strategies.
In total, six states have had well-developed value-based care strategies in place for four years or longer, 34 are two or more years into implementation, and eight states are in the early stages of value-based development.
Only four states have had little-to-no value-based payment activity.