Specialty Providers in the Age of Value-Based Care: Harnessing the Power of Data

Team Innovaccer
Fri 22 Sep 2023
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Data can play a pivotal role in helping specialty providers transition to value-based care (VBC). These providers, like others in the healthcare industry, must also adapt to this evolving landscape, albeit with their own set of unique challenges.

In this blog, we will delve into the critical components of this transformation, ranging from the significance of data interoperability to the specific hurdles that specialty providers face when embracing value-based care. Additionally, we will explore the role of data gravity in shaping cloud strategies and how it can address some of these challenges. Throughout, we'll highlight the ways in which a unified data model can assist specialty providers in successfully navigating this transformative journey.

"Specialist costs are high, and frankly, specialists have struggled to address this issue. Without comprehensive patient data, their efforts have proven inefficient and duplicative. To successfully adapt to the value-based care shift, specialists must proactively focus on driving greater efficiency and effectiveness."

- Mike Sutten, Chief Technology Officer, Innovaccer

Navigating the Data Readiness Crisis with a Specialty Lens

Electronic health records (EHRs), patient portals, insurance forms, and other sources can create data silos that hinder providers from realizing the full potential of cost-effective, quality care. The top technology barrier to overcome in healthcare is access to clean, centralized, shareable data to achieve interoperability. A cloud-native, interoperable data and analytics platform capable of connecting to virtually any HIT system, including EHRs, and unifying its data to make it useful across care settings is a key first step.

The Data Dilemma within EHRs

EHRs are data powerhouses but lack the essential tools for robust analytics and integration. As the use of data in healthcare expands, this deficiency results in an overflow of low-quality data. Using data effectively necessitates asking the right questions and leveraging insights to drive targeted interventions and enhance patient outcomes.

Enhancing Efficiency through Collaboration

Collaborating with risk adjustment experts can help minimize administrative burdens and improve financial efficiency. Accurate data unification is crucial in the revenue cycle because it streamlines claims processing, reduces care delays, and enhances patient satisfaction.

The Call for Digital Trust

According to Gartner, healthcare organizations that establish trust throughout their data collection process will be better positioned to extract business value from the data they collect. Furthermore, organizations with digital trust can expand data sharing into 50% more ecosystems, creating additional revenue opportunities. The report also underscores the costly consequences of poor data quality, with an annual cost of $12.9 million for organizations. Beyond the immediate financial implications, subpar data quality can perpetuate uninformed decision-making in the long term.

We can picture a patient's medical journey involving multiple touchpoints, from primary care providers to specialists, labs to insurers. To effectively harness EHRs and other technological advancements for improved patient care, timely diagnosis, and treatment, a seamless exchange of patient data is paramount.

Challenges Specialty Providers Face in the Transition to Value-Based Care

As healthcare, including specialty practices, continues its shift towards value-based care, the focus is transitioning from volume to value. However, statistics indicate that analysts typically spend 80% of their time searching for data, leaving only 20% for actual analysis.

One significant challenge is the standardization of data across diverse systems and settings. For instance, healthcare providers, especially specialty practitioners like cardiologists, must extract insights from a wide array of sources, including hospitals, laboratories, and EHRs, to deliver comprehensive patient care. However, these sources often employ different data formats, coding standards, and terminology, resulting in data silos that impede effective communication and coordination.

To address this challenge, providers can invest in interoperable technologies that facilitate the consolidation of data from various sources. This may involve mapping data elements to standardized terminologies, converting data into a consistent format, and establishing mechanisms for data exchange.

This approach provides specialty practices with access to a unified patient record that encompasses a comprehensive view of the patient's health history. Consequently, it enables providers to make better-informed decisions, develop personalized treatment plans, and enhance patient outcomes.

Longitudinal Patient Records: The Holy Grail for Specialty Providers

  • Automating the Integration of Diverse Data Sets

    To create comprehensive longitudinal patient records, it is essential to automate the integration of diverse data sets. This data-driven approach empowers providers with a complete patient healthcare timeline, enhancing care quality and streamlining administrative tasks for greater efficiency.

  • Achieving a 360-degree Patient View

    The Patient 360 concept harnesses predictive analytics and comprehensive data to facilitate personalized care and timely interventions for patients at risk of chronic conditions. It fosters patient engagement, identifies care barriers, and supports informed decision-making while seamlessly integrating real-time remote monitoring for optimal health management. Specialty providers embracing this holistic approach can significantly enhance their ability to deliver proactive and effective healthcare.

  • Promoting Unified Patient Data Sharing and Collaboration for Personalized Solutions

    This approach contributes to informed decision-making, reduces medical errors, and enhances patient outcomes. It also facilitates efficient communication among providers, minimizes redundant tests, and builds patient trust. Leveraging interoperable systems like FHIR and patient portals ensures seamless integration while empowering patients and facilitating personalized care.

Achieving True Interoperability with Data Gravity

Data gravity functions like a magnetic force, attracting information and applications closer to the point where data originates and resides. In the context of specialty care, this concept carries significant importance. The closer providers can get to a patient's medical history, test results, and treatment plans, the more efficiently they can deliver specialized care.

In specialty care, cloud strategy revolves around harnessing the potential of data gravity for providers. By utilizing cloud services, healthcare providers can effortlessly access, analyze, and share crucial patient information, transcending geographical boundaries. This enables specialists to collaborate seamlessly, resulting in expedited diagnoses and tailored treatments. Ultimately, it enhances the quality of care and improves patient outcomes.

Data Transformation: A Key Driver of Financial Performance for Specialty Organizations

Data transformation plays a pivotal role in enhancing the financial success of specialty providers, particularly in the context of healthcare's shift towards value-based care. Specialty providers have the opportunity to align themselves with Accountable Care Organizations (ACOs), leading to significant improvements in patient care qualnhjity and financial performance.

  1. Enhanced Decision-Making: Data transformation empowers organizations to derive valuable insights from diverse data sources, facilitating more informed financial decision-making. This, in turn, enables specialty providers to allocate resources more efficiently.
  2. Cost Optimization: Value-based care models prioritize cost-efficiency. Data transformation aids in identifying inefficiencies, reducing unnecessary expenses, and ultimately improving profitability.
  3. Predictive Analytics: Advanced data transformation techniques, including machine learning, enable organizations to predict patient needs and proactively address them, resulting in fewer hospital readmissions and reduced associated costs.
  4. Revenue Enhancement: Through the utilization of data, specialty organizations can pinpoint high-value services, negotiate advantageous contracts with ACOs, and tailor their offerings to meet evolving patient demands. This strategic approach contributes to the enhancement of revenue streams.

How Can Innovaccer Help?

Innovaccer is at the forefront of helping provider organizations move beyond point solutions and basic interoperability to true data readiness, using a scalable platform that accelerates innovation and digital transformation in healthcare.

Innovaccer’s population health management suite (PHM) helps providers and specialty care practices achieve better health outcomes, exceptional patient experiences, reduced care and administrative costs, and improved revenue regardless of where they are on their journey to value.

At the heart of these capabilities: The Innovaccer Platform which creates a unified patient record by rapidly establishing the highest level of interoperability between legacy, mission-critical, and other healthcare IT systems; aggregates and unifies (cleans) the data from multiple sources; “hydrates” the data to enable any application to use it; “activates” the data to make it useable in integrated workflows; and lastly, “harmonizes” the data to ensure it’s synchronized across all relevant systems and care settings.

Learn more about or schedule a demo with our experts to see how Innovaccer can help your organization accelerate your transformation to value and realize improved clinical, financial, experiential, and operational outcomes across the continuum of care.


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