Ask multiple healthcare providers “what is value-based care,” and the answers likely will vary based on the individual provider, his or her specialty or type of healthcare system in which he or she practices. Yet, a key point that remains steadfast regardless of the care setting is that the patient is at the center of a value-based healthcare delivery system. Value-based care focuses on quality and outcomes and puts the patient at the heart of the healthcare experience.
The shift from a fee-for-service model that pays providers based on volume to a value-based reimbursement method that rewards quality over quantity is in full swing throughout the healthcare industry. Although CMS has a goal of bringing 50 percent of Medicare reimbursement toward value-based alternative payment models by the end of 2018, a May 2017 survey reveals that just under one-fourth of hospitals indicate their net patient revenue is value based. Respondents expect this to more than double to 48 percent within three years. Other studies suggest that nearly 60 percent of payments will be value-based by 2021.
Indicative of the growing movement toward value-based healthcare, preparing medical students for work in a value-based world was listed as one of the top 10 forces that will have the most impact on the healthcare industry in 2017. It is so powerful that some medical schools are incorporating a value-based care curriculum. The goal is to better prepare graduating physicians to work on the cross discipline teams that are the norm in a value-based healthcare environment.
For those new doctors as well as more seasoned practitioners, the thought process must shift from volume to value as the industry continues to look for ways to measure and continually improve upon the value, cost and quality of care in a value-based, data-driven setting.
Data at Center
If the patient is at the heart of value-based healthcare, then data is the “lifeblood of the value-based payment environment.” Value-based healthcare depends on quality data collection and precise data analytics to extract data that can inform decision making to help control costs, eliminate duplication of services, improve efficiencies and make it easier for patients to get the care they need.
In many cases, a value-based healthcare delivery system helps providers develop and deliver population health initiatives that improve care and outcomes using data from a certain patient population or disease state. This is particularly true in Accountable Care Organizations (ACO), where providers reap monetary rewards for successfully managing and improving the health of an entire population. Other value-based care models include the patient-centered medical home that is led by a primary care physician who coordinates a patient’s care, a pay-for-performance model that rewards improved quality and lowered costs, and bundled payments based on expected costs for a particular course of treatment.
Regardless of the value-based care delivery model, data must be at the center of the process to drive the right care decisions at the right time. From data collection and entry to aggregation and access, putting the right information at the provider’s fingertips is essential to improving care. Value-based care also depends on having quality data that can be securely stored and accessed.
On the financial side, the same level of quality, accessible data is integral to economic success in a value-based payment environment. Because value-based healthcare reimbursement focuses on the quality of services rather than the quantity, providers must become more aware of available data and the clinical decision support tools that can help drive cost-effective care decisions. As an example, eliminating unnecessary tests and the resulting expense aligns with the principles of value-based care. But a broader scale, integrating clinical data with claims data helps improve analytics capabilities and, in the end, contributes to better reimbursement rates and improved financial performance along with higher patient satisfaction.
Quality Data Drives Quality Care
Value-based healthcare is data driven. Success is contingent on consistently collecting and exchanging complex data and making it easily accessible – often via a cloud-based data integration and management platform – to care givers. The data, in turn, guides and supports treatment decisions. At the same time, future patients benefit from the same data when the healthcare system utilizes data analytics beyond individual patient care to develop care protocols for specific patient populations.
This forward thinking approach requires a data management platform that supports a comprehensive set of data that is collected over time, aggregated and utilized to identify and also manage patient populations, identify trends in disease treatment or gauge effectiveness of preventive measures. Further, systematic analysis of outcomes data from the electronic health record (EHR) and other data sources allows providers to identify and promote treatment protocols that result in better, more cost-effective care for patients now and in the future.
Simply having the data from the EHR is not enough. As more and more data is collected in an expanding number of ambulatory care delivery settings, it must be available to a growing number of providers across the spectrum of care. The data, in turn, drives care coordination, data-driven decision making and population health management. For example, quality data can support interventions to improve medication adherence, office visit compliance, chronic disease monitoring, and hospital admission avoidance. All of these are of high value to providers, patients and payers.
To effectively support this data explosion, data platforms must be interoperable, compliant, flexible and scalable. Healthcare providers must be able to exchange and access quality data in real time to make better care decisions. At the same time, the value-based healthcare system must be able to improve data integration, data exchange and overall data management to not only drive quality care outcomes but also support business goals and financial stability.
Value-based healthcare depends on effectively leveraging complex data and delivering that data to providers in an easily usable format that supports care decision making. There is no single best value-based healthcare model that fits all provider organizations. However, there is a commonality among all models – an underlying platform that supports data integration and management to achieve interoperability, improve care coordination and enhance patient outcomes while also maintaining or lowering costs.