AHIP, AMA, NAACOS Share Best Practices for Value-Based Care

Create an interoperable data ecosystem

Value-based care entities use multiple data systems, and a lack of data exchange standards has led to interoperability challenges. Stakeholders can improve data sharing and create an interoperable ecosystem by using data exchange networks to support data sharing across the care continuum.

Payers, providers, and other value-based care entities can also use a minimum standardized data set and data elements to facilitate more meaningful and useful data sharing across payers and use attachments for administrative transactions to improve clinical data requests and response processes.

Leveraging application programming interfaces (APIs) to improve access to EHR data and regularly coordinating with health IT vendors to ensure systems are updated can help foster interoperability. Stakeholders should also use contract terms that govern adherence to exchange standards and the use of a core data set. These standards should be tested in real-world settings and be clinically or financially relevant to contracting parties.

Share comprehensive data

Providing complete, comprehensive data can allow value-based care participants to better understand the patient population they are serving. However, demographic data, data integration, and data sharing are lacking.

Stakeholders can integrate clinical and demographic information at the individual and population levels; include individual and practice-level provider numbers on claims and reports and in EHR systems to facilitate data exchange and accuracy; and integrate pharmacy data.

On the payer side, providing aggregate population-level spending and treatment data, using standard credentialing information, and regularly sharing raw claims data with providers can help lead to comprehensive data.

Meanwhile, providers should maintain updated billing information and regularly submit complete claims to improve the timeliness of aggregated performance feedback.

Improve data collection to advance health equity

Collecting data from community-based organizations that offer insight into health-related social needs can help further value-based care. Data on health-related social needs can help organizations identify health disparities and barriers to care that go beyond the clinical setting.

Stakeholders can engage community networks and support health and non-health data-sharing networks to improve care and service coordination, the brief said. Additionally, including standards focused on health-related social needs in contracts can improve adoption and consistent use within clinical encounters and claims submissions.

Successful data collection may also require training and end-user support, improving patient communication about data use, and developing whole-person profiles that integrate community and population-level data with individual profiles.

Share actionable data

Receiving actionable, consistent, and reliable data on a timely basis can help healthcare practices develop proactive care interventions. Actionable data requires stakeholders to present relevant insights in an easily accessible and usable way.

Stakeholders should limit data at the point of care to actionable information to improve clinical decision-making and leverage existing data-sharing networks to share real-time information on patient admission and discharge.

Payers should shift away from proprietary portals to standardized data measures and processes for data sharing and automate data sharing when possible to accelerate performance feedback. Both payers and providers can create dashboards displaying cost, quality, and utilization data with contextual information to allow practices to easily monitor performance and identify areas for improvement.

Make data calculations readily & easily available

Lastly, ensuring access to complete data and the methodologies behind the data allow value-based care entities to design more effective interventions.

Payers and providers should share performance data regularly instead of only sharing historical data and provide a feedback loop for any data updates or corrections.

Payers participating in value-based care arrangements should share established or estimated benchmarks ahead of the performance period when possible and regularly share information on the reliability of estimates used in calculations.