For the past several years, the healthcare industry has been carefully edging toward the tipping point of value-based care. Regulators, payers, and many providers have been eager to push their partners forward into a new world of performance-based payments and revenue incentives for improving patient outcomes.
With a focus on financial accountability, influential stakeholders like the Centers for Medicare and Medicaid Services (CMS) and the nation’s biggest commercial payers have worked closely with provider networks to launch accountable care organizations (ACOs) and other innovative payment models. Thus far, their efforts have borne some significant fruit. In 2018, more than 60 percent of US healthcare payments flowed through alternative payment models with some sort of value-based component, according to the Health Care Payment Learning & Action Network.
While this figure seems very promising on the surface, a closer look at the data reveals a catch. A large proportion of the payments may have links to pay-for-performance incentives and upside-only risk arrangements, but a mere 14 percent have direct ties to the holy grail of value-based care: two-sided risk and condition-specific, population-based reimbursement. We still have a long way to go.
Encouraging and enabling healthcare providers to embrace two-sided risk models has been a huge challenge for payers, but it’s not always because of simple resistance to the idea of putting revenue on the line. Many physicians are eager to unlock the potential of value-based care and a population-level approach to preventive, holistic, proactive medicine. But they largely lack the tools, support, and technologies to deliver precision care to individuals while closely monitoring the overall health of their attributed patient panels.
The key to shifting more of the nation’s reimbursements into truly value-based payments is equipping providers with detailed, accurate insights that allow them to take evidence-based action at the point of care to control costs, improve outcomes, and deliver exceptional patient experiences.
The role of population health in value-based care
Population health management is the idea that providers can influence overall outcomes in a group of patients by applying evidence-based interventions to individuals in a proactive, standardized manner. The goal is to identify and forestall rising risks so that patients stay healthier and incur fewer costs, especially in the emergency room and inpatient settings.
For example, ensuring that all patients with a diabetes diagnosis receive A1C testing at appropriate intervals helps every individual make better choices to manage his or her health. When these interventions are conducted rigorously at scale, the gains of each individual add up to a healthier population as a whole.
And when these evidence-based activities are combined with a holistic approach to whole-person care, including addressing the social determinants of health, patients are much more likely to achieve their optimal health state.
Providers who are engaged in value-based care models can earn incentives and shared savings payments for performing well on quality measures that gauge these population-level processes and outcomes.
The need for a precision information delivery approach to population health management
This seemingly simple strategy actually requires access to a great deal of curated, relevant, and timely data. Providers must be able to visualize risk patterns in their patient groups, understand which interventions are applicable at every point in a patient’s health journey, gain access to the entire scope of clinical activities for each person, connect with patients to deliver personalized services, and measure the outcomes of these actions.
Unfortunately, providers have long struggled to easily access and apply any of the targeted, up-to-date information they need to assess their attributed beneficiaries and close gaps in care.
In 2019, a poll by Definitive Healthcare found that a more than a third of providers believe data-related issues are the top barrier to population health management. Fifteen percent cited trouble with collecting and reporting patient data as their biggest challenge, while an additional 20 percent blamed gaps in interoperability for sluggish adoption.
As we have discussed previously, this type of fragmentation is the enemy of value. The nation wastes hundreds of billions of dollars per year on clinical failures and administrative waste, much of which can be prevented with value-based financial strategies and health IT improvements.
To realize these gains, providers participating in the value-based ecosystem simply must be able to leverage contextualized insights to ensure they are closing gaps in care, facilitating well-coordinated whole-person care, and performing well on critical metrics.
Equipping providers with the tools to succeed with population health
To deliver effective services individually and at scale, providers need to reduce the time spent wrestling with gaps in information so they can have meaningful conversations with patients about the clinical and non-clinical challenges they are facing.
Remember Dr. Gomez and Mrs. Smith, a primary care provider and elderly patient working together on improving Mrs. Smith’s health?
In that example, Dr. Gomez was experiencing some very common challenges: a lack of timely information about Mrs. Smith’s clinical activities and an enormous cognitive burden around manually retrieving and assembling scraps of data from multiple sources.
But when Dr. Gomez left the onerous document-based exchange environment and switched to leveraging an automated, intelligent knowledge hub, she was able to take action to dramatically improve Mrs. Smith’s wellbeing.
Instead of spending hours each day logging into data portals, reading through faxed reports, and chasing down partners across the care continuum, Dr. Gomez was able to see all new available information about Mrs. Smith’s clinical history at a glance upon opening the chart, giving her the time and bandwidth to deliver true value to Mrs. Smith and her other patients.
Advanced applied intelligence with precision information delivery was the key for Dr. Gomez – and it’s the key for all providers who wish to succeed with population health management and value-based care.
With this new approach to bypassing data siloes and displaying critical information in a carefully curated, intuitive manner deeply integrated into the workflow, providers can stay one step ahead of rising risks and expensive utilization events.
As healthcare payers continue to encourage, facilitate, and enable providers toward increased financial risk and higher levels of performance on quality metrics, participants in value-based care arrangements will not be able to rely on the health IT status quo. Instead, they will need to adopt complementary innovative technologies to support their population health work.
Armed with comprehensive, action-oriented, precise insights into patients and populations, healthcare providers will be able to make the most of the value-based care models that represent the future of the healthcare industry.