Nuanced technology is critical to success in value-based care

The transition to new reimbursement methodologies will require data to flow easily between provider organizations and better oversight of care to cover care gaps.

This article is part of the July 2023 COVERstory.

Value-based care has been promoted as a reimbursement methodology that gets the wide spectrum of healthcare industry participants rowing in the same direction, aligning incentives in a way that negates the adversarial relationship inherent in fee-for-service relationships. 

So many challenges could be negated by value-based care – less emphasis on claims, prior authorization snafus and using electronic health records systems to justify claims. Patients could get better care, more attention paid to wellness, and they can get invited to participate more actively in their care. 

But to make it all work, data needs to be seamlessly shared, and new IT capabilities need to be incorporated to make healthcare organizations more proactive in anticipating issues for members, not just reactive when they have health issues. 

To achieve better results with value-based care, leading healthcare organizations and technology providers are re-imagining how to use information technology and looking at new capabilities to optimize their performance under value-based care. 

EHRs as a starting point 

Electronic health records systems (EHRs) are widely used by healthcare organizations, and now providers envision them playing a pivotal role in containing a wide range of patient information that supports value-based care approaches. 

Indeed, Priority Health, a Grand Rapids, Mich.-based health plan and provider, is looking to use its Epic EHR as a central source of truth powering value-based care efforts. Doing so obviates the need to sign into multiple systems to chase down patient records and perform various functions with data, says Michelle Ilitch, vice president of network solutions and value-based programs at Priority. 

Priority will augment the EHR with Epic’s payer platform, which will support care coordination and clinical document exchange, as well as quality reporting. She expects the transition for the entire system to the payer platform to take about 18 months, and it will help clinicians use the EHR to manage quality and eliminate any gaps in care for individual patients. 

“This is the second step in our evolution to achieve the quadruple aim,” Ilitch adds. “We are trying to make sure that providers are doing what they went to school for. We’re trying to take away some of the drama and focus them on creating value.” Priority is “leading with technology in its efforts to restore some of the joy of practicing medicine while “reducing abrasion – we want to help providers keep care within their practice walls and see the total picture for patients.” 

At Geisinger Health, technology supports an organizational vision for keeping patients healthy, enabling collaboration between primary care physicians and specialists, and pursuing a population health focus, says says Jonathon Welch, chief medical officer for population initiatives for the Danville, Pa.-based integrated delivery system. 

Technology provides an underpinning for sustainably providing care, emphasizing quality and minimizing variations in care, which makes care affordable for patients, government partners and employers, he says. 

To expand its value-based care approach, Geisinger is teaming with Kaiser Foundation Hospitals to launch Risant Health, a non-profit organization that aims to “expand and accelerate the adoption of value-based care in diverse, multi-payer, multi-provider community-based health system environments,” according to a press release from April. 

Risant, in its initial agreement with Geisinger, will make available expertise and resources to promote high-quality, evidence-based care to improve care with Risant’s platform “that offers the best in value-based care practices and capabilities in areas such as care model design, pharmacy, consumer digital engagement, health plan product development and purchasing.” The agreement between Risant and Geisinger is subject to state and federal regulatory review. 

Improving population management 

Achieving success with value-based care highlights the importance of data and consistency in records, notes Danielle Scheurer, MD, chief quality officer for the Medical University of South Carolina. She explains that claims data from payers and EHR data of providers don’t always match up well, which inhibits the delivery of effective, value-based care. 

To succeed, “a provider or health system really needs to get good at claims ingestion and ensure that what’s in the medical record is accurate,” she says. Tools in its Epic records system helps to harmonize and reconcile any differences. 

“Another example from an IT perspective is working with a vendor to seamlessly do outreach to patients who have care gaps,” Scheurer says. For example, the technology can enable the use of targeted messaging – for example, to specific patients who are eligible for a shingles vaccine or need a diabetic eye exam – rather than ineffective general messaging to a wide swath of patients. 

“It’s really about perfecting that data exchange and making it as seamless as possible, getting that customization and achieving patient-centeredness,” she says. “You don’t want to badger people, but you really do want people to get their preventive services as easy as possible, to get labs done or mammograms.” 

Enabling all organizations to have technical capabilities to achieve value-based care is a challenge, says Bradley Hunter, vice president of value-based care and core solutions for KLAS. “You have the progressive organizations, which are the big names – they can do whatever they want (with technology) and they’re well-equipped to take it on. Of the early adopters, many have made the shift and have figured out what the appropriate resources are. The smaller end of the market sees this as the way of the future, but they need a lot of help and guidance.” 

Cloud-based systems hold promise for enabling smaller, under-resourced providers to make the shift to value-based care. For example, athenahealth offers a cloud-based approach for its records system, enabling organizations to use analytics and population health management tools “at the moment of care” and not as separate or standalone systems running alongside a records system, says Michael Palantoni, vice president of product management and platform services for the company. 

With its cloud-based approach, athenahealth can offer a national platform “and do a single integration to connect to the entire provider base,” he says. “It can take advantage of the power of ecosystem-oriented technology, and it levels the playing field, decreasing costs” for users. 

“There are clearly pockets of the industry that are adopting (technology for value-based care) well and have thought about their technology,” he concludes. “But there’s a large part of the industry that’s struggling to adapt, trying to keep up. Value-based care requires a lot of communication around the patient, and providers need to be ready to operate in this world. If not, they will struggle with the cost of managing it.”

Return to the July 2023 COVERstory.

More for you

Loading data for hdm_tax_topic #reducing-cost...