As value-based care continues to transform the industry, there are gaps in healthcare that can only be closed through data exchange between clinical and payment systems.
That’s the finding of a new report from the Workgroup for Electronic Data Interchange. In particular, WEDI makes the case that automated data exchange is critical to the successful coordination, delivery and payment under value-based care.
Working with its sister foundation the Louis W. Sullivan Institute for Healthcare Innovation, WEDI identifies as a national priority “gaps in care” which they define as the “discrepancy between evidence-based recommendations or best practices and the care that is actually delivered.”
What’s needed, says WEDI’s Interim President and CEO Charles Stellar, is greater education and communication to raise awareness among stakeholders—particularly providers—about the value of identifying and closing gaps in care, which threaten the performance of healthcare organizations.
The lack of interoperability remains a significant barrier to fully leveraging health IT to assist team-based care coordination across the healthcare continuum, making gaps in care a critical issue for stakeholders, the report suggests. The importance of filling these gaps will only continue to grow in importance as value-based care efforts mature and health insurance coverage expands.
“Many providers are unable to seamlessly access or share patient health information electronically with other organizations,” the report says. “As a result, they are unable to efficiently identify patients in need of healthcare services or deliver services according to evidence-based guidelines in a timely manner. Not closing these gaps in care significantly affects the quality and cost of care by contributing to adverse patient outcomes and inappropriate care.”
For its part, the Sullivan Institute conducted mixed method qualitative research, evaluating how healthcare stakeholders are approaching gaps in care across the country. Results from a 2015 Sullivan Institute survey included in the report indicate that 57 percent of providers and 83 percent of health plans currently have services or programs that aim to reduce gaps in care, while an additional 20 percent of providers and 8 percent of health plans are looking to implement such efforts in the future.
At the same time, WEDI notes that those surveyed “do not fully understand the potential impact of gaps in care on their organizational performance.”
WEDI’s Stellar argues that consensus is needed to develop and standardize quality measures and methodologies for information exchange among health plans, providers and patients.
“We still have systems that do not necessarily talk to each other,” contends Stellar. “Patients should be more involved in the process, with shared decision-making between patients and providers. But, to achieve that, you need health information that is accessible to all parties and in a format that everyone can access.”
However, when patient data is inaccurate, incomplete or out of date, providers and health plans may make bad decisions, which can harm patients and the lower overall value of the services and benefits delivered.
To address these shortcomings, WEDI recommends that the terminology, standardization and scope of gaps in care measures requires clear definition and alignment between health plans and providers before actionable data harmonization can occur. Further, best practices need to be disseminated that illustrate stakeholder roles, automation of workflow and quality improvement, according to the report.
Other technical barriers to exchanging gaps in care information cited by WEDI include the provenance, quality, completeness, timeliness, transparency and accuracy of data. “Efforts enabling the advancement of open-API and element-based exchange, allowing more seamless exchange of data, are needed to address current systems and organizational infrastructure designs,” concludes the report.
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