Tag Archives: Risk Stratification

Healthcare execs say EHRs don’t do enough to manage value-based contracts

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https://www.healthcaredive.com/news/healthcare-execs-say-ehrs-dont-do-enough-to-manage-value-based-contracts/518330/

Dive Brief:

  • A survey of 100 healthcare executives found that most of them are seeing ROI on value-based contracts, but investments in EHRs are not sufficient to manage those contracts.
  • The Sage Growth Partners study found most respondents were not satisfied with their EHRs’ “ability to help them manage core functions necessary to succeed in (value-based care) — such as care coordination, risk stratification, decision support and patient engagement.”
  • About two-thirds of respondents said EHRs are not delivering promises concerning lower costs, better population health management and improved patient and physician satisfaction.

Healthcare providers are increasingly looking to EHRs and third-party population health management solutions to help them with value-based care.

A recent Healthcare Financial Management Association (HFMA) survey found that value-based payment programs doubled since 2015. Nearly three-quarters of executives in the HFMA survey said their organizations achieved positive financial results, including return on investment, from value-based payment programs.

Although providers expect value-based programs to continue to increase, the new Sage Growth Partners survey found dissatisfaction with EHRs and concern they are not helping enough in value-based care. The report found 64% of respondents said EHRs haven’t delivered many critical value-based tools. At least 60% of respondents said they are looking for value-based solutions beyond EHRs.

The survey included a finding that will likely get the attention of EHR and population health management vendors — half of respondents said they are somewhat or highly likely to switch population health management vendors over the next three years.

Nearly three-quarters of survey respondents have had an EHR for at least three years. About half also have third-party population health management solutions. These findings offer a glimpse into the dissatisfaction as well as opportunity in population health management.

The executives surveyed said there are issues with interoperability, addressing social determinants of health, patient engagement, stakeholder coordination and risk analytics. They also spoke of health systems having trouble aggregating and using data from numerous EHR systems and other data sources.

These issues have led half to two-thirds of healthcare executives turning to population health management or do-it-yourself solutions beyond EHRs “to compensate for the lack of these capabilities within their EHRs.” Many of those executives said population health management solutions enabled their value-based success. Those successes are also coming at a lower cost than the investments in EHRs.

The study authors predicted more healthcare executives will look beyond EHRs in the coming years to help with value-based contracting. They said “suboptimal tools” that manage care and costs for populations won’t be enough in coming years.

“As (value-based care) reaches the tipping point, and as they take on programs with greater risk and greater complexity, they will need to continue looking beyond their EHRs to get the functionality they need,” the authors wrote.

 

Why an “Empty Desire” for Big Data is Inhibiting Value-Based Care

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http://healthitanalytics.com/news/why-an-empty-desire-for-big-data-is-inhibiting-value-based-care?elqTrackId=7e1ea6a5e2184a469cc018b890eccc22&elq=03ec8f5a4aad45249c8fc7202a9a18d4&elqaid=2412&elqat=1&elqCampaignId=2218

Value-based care and big data in healthcare

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.”

Nonacute Care: The New Frontier

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http://www.healthleadersmedia.com/leadership/nonacute-care-new-frontier?spMailingID=10066722&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1061461419&spReportId=MTA2MTQ2MTQxOQS2

Image result for New Frontier

What happens outside the hospital is increasingly important to success, so healthcare leaders need to influence or control care across the continuum.

If you’re running a hospital, one irony in the transformation toward value in healthcare is that your future success will be determined by care decisions that take place largely outside your four walls. If you’re running a health system with a variety of care sites and business entities other than acute care, the hospital’s importance is critical, but its place at the top of the healthcare economic chain is in jeopardy.

Certainly, the hospital is the most expensive site of care, so hospital care is still critically important in a business sense, no matter the payment model. But if it’s true that demonstrating value in healthcare will ensure long-term success—a notion that is frustratingly still debatable—nonacute care is where the action is.

For the purposes of developing and executing strategy, one has to assume that healthcare eventually will conform to the laws of economics—that is, that higher costs will discourage consumption at some level. That means delivering value is a worthy goal in itself despite the short-term financial pain it will cause—never mind the moral imperative to efficiently spend limited healthcare dollars.

So no longer can hospitals exist in an ivory tower of fee-for-service. Unquestionably, outcomes are becoming a bigger part of the reimbursement calculus, which means hospitals and health systems need a strategy to ensure their long-term relevance. They can do that as the main cog in the value chain, shepherding the healthcare experience, a preferable position; but physicians, health plans, and others are also vying for that role. Even if hospitals or health systems can engineer such a leadership role, acute care is high cost and to be discouraged when possible.