Making Data Sharing A Condition in Value-Based Contracts

Healthcare data sharing is central to a successful value-based care strategy, according to Jamie Reedy, MD, MPH, chief of population health for Summit CityMD.

“If the physicians and care teams don’t know their quality scores, or they don’t know if they’re actually getting the right patients in for care, or they don’t know that their patients have actually been hospitalized or in the ER, then they’re not going to be able to appropriately manage the outcome that we negotiate in our contracts,” Reedy recently told RevCycleIntelligence.

But accessing all the data necessary for appropriate care management can be a major challenge for providers, especially those in value-based contracts like Summit CityMD, which participates in the risk-heavy Next Generation ACO Model and several downside risk models in the commercial space.

Everyone is producing data that can inform a value-based care strategy, from health plans and providers to state-level agencies and other facilities across the care continuum. Yet sharing that data has not always been easy for all those involved in patient care.

Lack of interoperable health IT systems and data standards, technology inadequacies, and worse, information blocking and other unsavory practices that restrict the exchange of healthcare data have all contributed to data sharing issues in healthcare. And in turn, value-based care deficiencies.

At Summit CityMD, for example, the limitations of data sharing prevented providers from tracking patients throughout their healthcare journey. So if a patient presented to the emergency room or was admitted to the hospital, providers could not follow up to prevent a readmission or a potentially avoidable visit in the future, at least in a timely manner.

“We'll get lists of patients who went to the ER last month, but what good is that if by the time you call the patient, their problem has already resolved or they've already gone to see an expensive orthopedist for an ankle sprain that they could've seen a primary care physician for,” asked Reedy. “It's absolutely critical that this information be received timely and then acted upon timely in order to make it meaningful and to do the right thing for the patient.”

In order to collect the information necessary to get ahead of potentially avoidable utilization, the medical group implemented a platform from PatientPing and Arcadia that provides admission, discharge, and transfer (ADT) data notifications to providers in real-time.

The platform has been key to improving the timeliness of patient outreach, but also aggregating data from the two other key sources Summit CityMD uses: health plans and a state-run health information exchange.

“All three of those sources have significant benefits, level of overlap, and also distinctions,” Reedy stated. “We combine all three into [the platform] because that gives us the fullest most comprehensive picture of where the patients we are at risk for are going across the medical neighborhood, not just hospitals, but also emergency rooms, skilled nursing facilities, acute rehab, home health agencies, and so forth.”

“That data is really critical to managing the health of a population we are accountable for,” Reedy stressed.

Having a single source of information has also helped Summit CityMD providers reduce duplicative services and, generally, have better conversations with patients since the platform can call on data from the EHR system, claims, and other sources.

“That comprehensive combined data set informs the conversation with the patient in a better way. It helps the patient feel better about the fact that we actually know so much about their healthcare and are staying on top of all of that,” Reedy said.

To keep the platform fueled with the necessary data though, the medical group has also put data sharing on the table when negotiating value-based contracts.

“When we negotiate our value-based contracts and we take accountability for our population of patients, we do include in our contracts with the health plans that they must provide us claims data and these daily notices of admissions, discharges, and transfers. We make it contractually such that they're obligated,” Reedy explained.

The group also includes in contracts the exchange of eligibility files and raw medical and pharmacy claims files on a monthly basis, as well as curated reports, such as patient leakage reports or specific site of care opportunities.

“We negotiate with each of our health plans for a set of reporting and analytics that's going to accelerate our ability to be successful initially in that contract and allow us time to get to know how to use the data from that particular health plan,” Reedy elaborated.

This is critical since every health plan has different data sources and formats, which leads to variations in comprehensives of claims and other data points, Reedy added. Therefore, aggregating the data into a single platform and gleaning insights from those points will take time and potentially more negotiation later on.

Therefore, providers should “ask for everything you think you're going to need to manage the population,” Reedy advised.

“And if you have an attribution model that ultimately results in patients becoming attributed to you after they've started seeing you for primary care, then you may want to cast the net wider and start requesting data for any patient who comes to you for primary care, regardless of whether they're attributed or not,” the population health expert also recommended. “Have that data to manage upfront and optimize that patient's care and cost of care even before they become officially attributed.”

With more meaningful data from health plans and other sources, practices can also start to make more informed decisions about operations and even primary care compensation. But overall, the data enables groups like Summit CityMD to deliver value to all patients by gaining a clearer picture of their populations.

“We want to have one standard clinical model at Summit. We really want to know about these admissions, discharges, and transfers for all of our patients that call us their medical home and for all patients that come to us for primary care,” Reedy said. “That's not possible if the health plans are only sending us lists for patients that are only attributed to value-based contracts.”