Out with the Confusing EHRs: In with the 5 Fundamentals of Value-based Care

Abhinav Shashank
Tue 15 January 2019

The value-based care preposition is rightly endorsed as the way forward for the US healthcare system. Our care delivery model is rapidly transitioning but by no means is the transition easy. While all organizations share somewhat the same goals―improving population health outcomes, enhancing the patient experience, reducing care costs, and eliminating physician burnout― the paths they choose to achieve those results vary by leaps and bounds.

If you cannot measure it, you cannot improve it.”

Unsurprisingly, this famous management adage is as true for healthcare as any other sector. Many organizations struggle to identify the areas they need to focus on based on the general industry trends and practices and channelize their resources towards things that need less attention. Each care delivery organization has different needs, challenges, and solutions. Not only do these needs differ from organization to organization, but even between two facilities within the same umbrella organization. As it turns out, something which may seem easy for an organization to achieve may be the biggest issue for another, even just a few miles away.

While the evolution process for each organization is different in terms of infrastructure, there are certain common components such as care delivery structure and financial implications which determine the success of organizations shifting towards a value-based care model.

Aligning internal and external goals – Organizational structure and proper governance

It’s really significant to have a leadership team working toward achieving a common goal. Providers have the lion’s share in determining the overall success of an organization, and we need healthcare leaders who can work in tandem with their providers to identify their pain points. Both provider and payer organizations need to develop a team of highly skilled and empathetic leaders to steer healthcare to efficiency.

Successfully managing an organization-wide changeover to value-based care requires a drilled down strategy. The leaders are not the only ones who need to align the business model with the best practices for care and quality outcomes, but they also need to keep every stakeholder on the same page throughout the transformation. It is essential to the success of an organization that the individual goals are aligned with the overall goals so that every employee has a clear idea about things they need to do.

Further, leaders need to ensure that their providers are satisfied with their jobs and responsibilities. Even the slightest negligence of providers’ interests can have a severe impact on the organization. Providers need to be engaged― from the initial steps of planning a value-based strategy to delivering care. In fact, it is the responsibility of the leaders to enable shared decision-making, track underperforming providers, and communicate with each member of the care team more effectively to improve their efficiency.

Leadership should also remain at the top of regulation changes and new trends flooding the healthcare market. It is also paramount for them to analyze the new mandates and practices and design the best strategy to build an excellent future.

Having the right data at all times

The present and future of value-based care are incomplete without a data-driven foundation. Delivering quality care requires providers to have concrete information and evidence to complement their medical wisdom. Providers have continued to focus on the quality of care; however, utilization optimization is still a relatively new concept for them in the broader sense.

With a fine-tooth comb approach, organizations can ensure that they sail effortlessly in a value-based care ecosystem, and for that to happen, they need data. Although EHRs have played a significant role during the digitization of healthcare, they still remain somewhat on the complex side in terms of the ease of usability. Also, EHRs only contain one facet of healthcare data.

Nearly one-third of patients experience a gap in their medical information exchange. Such gaps have a long-lasting impact on both care and cost outcomes. Some of the consequences of such gaps include excessive utilization, redundant care procedures, and medical complexities, among others.

Source: Gaps in Individuals’ Information Exchange, Health IT Dashboard, The Office of the National Coordinator for Health Information Technology

Physicians spend a considerable amount of their time toggling between different tabs looking for laboratory, prescription, and financial data for their attributed patients. Lack of information limits physicians from performing certain activities—ranging from identifying cost-effective practices for patients to deciding the best SNF, rehab, or home care program.

Organizations need cutting-edge data warehouses which can enable data aggregation, ingestion, and sharing across the system with the utmost accuracy. Having a single source of truth to power the most critical clinical and financial applications can make the transition to value-based care extremely smooth.

Focusing on Population Health Management

Once organizations have the right data, they should invest their time in deducing the best practices for Population Health Management (PHM). In its truest essence, population health management aims to enhance the health outcomes of any group of individuals while making efforts to ensure that those outcomes do not vary drastically on a case-by-case basis.

PHM is all about allowing the patient to win; it is about imparting care which is both cost-effective and timely. In the last few years, there have been a lot of discussions around PHM and how organizations can create a winning strategy to manage their populations more effectively. Health outcomes can vary for patients attributed to the same organization based on socioeconomic factors, facility type, and more. For value-based care organizations, it is extremely crucial to minimize such deviations.

Risk stratification and social determinants of health (SDOH) are two crucial components of an effective population health approach. It is still extremely significant to create systematic blueprints for each one of them.

No single team or technology can address the end-to-end needs of the patient population. As more organizations focus on developing concrete PHM strategies, the scope of cutting-edge and multidisciplinary technologies in the healthcare space will increase considerably. Additionally, more innovations and investments will disrupt the healthcare sector. According to an estimate by the Bureau of Labor Statistics (BLS), the job prospect for health information technicians will have a 13% increase by 2026. As we progress, emerging technologies such as Artificial Intelligence and Machine Learning will drive healthcare efficiency.

Organizations who manage their populations effectively not only optimize care and cost outcomes but can also unburden their facilities by enabling preventive measures.

Developing a patient-centric care management strategy

Once patients are stratified into different categories, providers can approach their attributed patients in a more targeted fashion. Coupled with the right data at the point of care, they can make more informed decisions; however, data analytics are only as good as the data itself. It is a prerequisite to have utmost data accuracy to build a care delivery model based on that data.

The US healthcare system still works in silos. In fact, as per the CDC, about 12% of patients do not have a fixed place to go for medical care. Care management aims as moving away from the episodic-care model to a more holistic approach of looking at patients. It also aims at building a patient-provider relationship based on trust.

It is a well-known fact that chronic diseases contribute a substantial amount to our healthcare spending. CMS predicts that about 117 million people suffer from one or more chronic diseases. These patients have needs that organizations must address based on evidence and assist them at a more interpersonal level.

To create a sustainable value-based care model, healthcare leaders need to ensure that each attributed patient is taken care of in a similar manner. Excessive utilization associated with a handful of patients can also determine the overall quality of care.

Provider organizations need to empower their providers with contextual information right at the point of care. Gaps in care at any level impact care outcomes at all levels. They need to know everything that happens with their patients at outside facilities, and should not be asked to shuffle through various records to pinpoint that information. In today’s age of intelligence, having relevant data should be one of the key priorities of both payer and provider organizations.

What leaders also need to do is to intelligently assign patients to their provider teams and listen to both their providers and patients candidly. The very soul of care management lies in listening to patients and looping them aggressively into their care journeys. In addition, providers need to educate patients in order to increase their awareness and ensure continuity of care.

Listening to your physicians

More than 42% of physicians report a feeling of burnout. To put this in perspective, this equates to a large percentage of dissatisfied care providers who were once more empathetic and happy with their jobs. On the other hand, engaged physicians are 26% more productive and generate revenue in excess of $450,000 for their organizations.

No organization can take these statistics lightly. Physicians generally know more about the health of their patients than anyone else and remain in direct contact with them throughout their care journeys. However, physicians spend a considerable amount of time finding and compiling relevant clinical and claims information, so much so that a quarter of total healthcare costs in the US is associated with administrative costs.

Physicians don’t need to bother themselves with data management, nor should they be expected to churn out relevant numbers every now and then. They should be allowed to focus solely on imparting quality care which is in the best interest of patients and organizations. They should be given ample time to create the best care delivery practices and listen to their patients during a care episode.

Physicians do the heavy-lifting of managing patient health along with their care teams, and they need the right resources to do that with perfection. They need point-of-care insights popping-up on their systems each time they see a patient so that they can dedicate their entire time interacting with their patients.

Healthcare leadership also need to involve their physicians in crucial decisions regarding their organization. Whether it is discussions around payment models or changes in technological infrastructures, physician alignment is an essential part of value-based care delivery. Their insights can be crucial for leadership as they create a plan to thrive in the ever-changing landscape of healthcare.

The road ahead

Federal and private organizations alike are steering healthcare towards a more patient-centric, value-driven ecosystem, but there is still a long way to go. We are stepping into an age of intelligence and have the right tools to maneuver the current healthcare system into an affordable one. It’s true that we need value-based care, but before that, we need a strategy around how we can plan to advance value-based care. Healthcare organizations need well-thought strategies, a clear vision of opportunities ahead of them, and a team-based approach to drive these operations―all powered by the right technology. The future of healthcare looks promising, and we need to keep working together to achieve the common goal.


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