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While value-based care is instilling more efficiency in the U.S. healthcare system, the need to procure and share additional data with other healthcare participants can be overwhelming. Before risk-based payment models had come into existence, under fee-for-service, simple information such as the names of the tests, assessments and procedures were sufficient for processing claims. However, under value-based contracts, healthcare payers also need to know the results to measure the quality of care outcomes. This includes items such as lab results, admission and discharge information, body mass index, vital signs and results of screening procedures and preventative health assessments.

The transition to value-based reimbursement in healthcare has created opportunities and challenges for health systems, physicians, and payers alike. Among all the interactions these stakeholders have, the relationship between physicians and health systems remains the most critical to clinical quality and efficiency, as well as the competitive success of each player. 

Healthcare consumerism is growing at an unprecedented rate, and health plan members are keen to access their healthcare data. When the data is relayed in a way that is easy to comprehend, with limited intricate technical terms, members can make prudent choices. Imparting information does not only empower the members, but it is also mutually beneficial. Along with healthcare data, if payers provide members with additional information about other health plans with lower out of pocket expenses, lower premiums and more coverage they can enable them to pick the most suitable plan and thereby instill brand loyalty. 

Every year health plans are required to gather and report their patient data for evaluation based on the Healthcare Effectiveness Data and Information Set (HEDIS®), a set of performance metrics established by the National Committee for Quality Assurance (NCQA). Until 2019, 90 percent of the health plans used HEDIS to measure their performance.

Healthcare is perhaps one of the largest sectors in the U.S. and has evolved from numerous points of view, with healthcare data rising to become its deep-rooted member. Despite the developed and specialized technical proficiency today, healthcare organizations are struggling with data irregularities, missing data, and legacy systems. The significant reason for these issues is the lack of knowledge about population trends. Population health management has developed from an idea to become a clinical discipline that works on consistently refining and developing measures to improve citizens’ health status. A thriving population health management program strives to deliver vigorous and coordinated care through a well-managed partnership network.  

While thousands of people continue to suffer the grave impacts of the COVID-19 pandemic, many have experienced hardship in other ways as a result of delays in needed medical and surgical interventions. Although postponing a majority of non-emergency surgeries was necessary for a time, hospitals need to be prepared as elective procedures are being reconsidered and might bounce back with a surge in cases.