For the most part, the healthcare industry has embraced the idea that access to big data is a critical part of doing business in the modern care environment. But there’s a major difference between having big data and leveraging it effectively for cutting costs and improving quality.
The chasm is growing between organizations that simply have access to data and those who know how to use it well, argues Shahid Shah, Entrepreneur-in-Residence at the AHIP Innovation Lab, and the resulting imbalance of information is making it difficult for payers and providers to truly make the leap into value-based care.
If provider organizations and their payer partners wish to bridge those gaps and prepare for a financial environment that prioritizes better outcomes, they will need to completely overhaul their approach to developing quality metrics, designing their health IT environments, and quantifying their data-driven relationships.
The process must start with taking a closer look at what payers really want or need when they talk about sharing information.
“Payers have an empty desire for data,” Shah told HealthITAnalytics.com at the HL7 FHIR Value-Based Care Summit in Chicago.
“It’s empty because it’s not in contracts yet. They haven’t reached the level of sophistication where they can accept data from providers and do something meaningful with it. If providers actually started giving them data, they wouldn’t know what to do with it, because they don’t have the systems in place.”
While there are still some technical challenges that make data aggregation and analytics a problematic proposition, the bigger issues are cultural, organizational, and legal.
“The infrastructure isn’t the main obstacle,” explained Shah, who is also Co-Founder and CEO of Netspective Communications. “Developers will always try to solve whatever problems you throw at them, even if it takes a while. There is nothing that a developer won’t eventually be able to do.”
“Data blocking and the inability to share data really happen because we haven’t created the demand ecosystem for interoperability. The fundamental flaw of our so-called desire for interoperability is that we haven’t reduced it to a transaction that can be measured and monitored in legal terms.”
The current generation of value-based care contracts simply don’t contain the necessary language to establish clear parameters for effective data sharing, he stated.
“They just don’t deal with data,” he said. “There aren’t clauses that say things like, ‘I want you to send me this amount of data on this number of your patients over this period of time using this particular standard so that I can calculate these ten measures using such-and-such as the denominator, et cetera.’”
“Instead, payers ask for raw data so that they can compute the measures on their own, but that can lead to conflicts with providers and confusion over payments. We need a better way to share data – and better data to share – if we’re going to make value-based care work.”