Preparing Providers for Value-Based Care, Consumerism in Healthcare

Transforming raw data into actionable information is crucial to the financial future of provider organizations, especially as pressure builds on providers to align their care delivery approach with value-based care and consumerism in healthcare.

However, many providers lack the time and money to implement this critical function. Fortunately, the right technology can assist providers in getting the most out of their data while freeing up resources better used for patient care.

Providers must be prepared to retool their financial and clinical strategies in light of industry-wide changes.

Approximately 59 percent of healthcare dollars are already tied to value and/or quality, according to a recent report from the Health Care Payment Learning & Action Network (LAN). Value-based reimbursement also accounts for nearly one-half of business (47 percent) for major payers and health systems, including the likes of Cleveland Clinic, Geisinger, and Partners HealthCare.

These alternative models of care have the potential to reduce costs, improve health outcomes, and deliver patient-centered care by holding providers accountable for quality improvements. Some stakeholders are already seeing the clinical and financial improvements from such models.

At the same time, consumerism in healthcare is significantly impacting provider organizations. Patient financial responsibility is steadily increasing as consumers continue to enroll in high-deductible health plans or plans with increased cost-sharing arrangements. With newfound financial responsibility, patients demand the highest quality care at the lowest possible price. A demand that just so happens to align with the ultimate goals of value-based care and healthcare reform.

But implementing strategies to account for these and other growing trends is not simple. Providers need a comprehensive view of their patient populations, including but not limited to their clinical, financial, and socioeconomic information. Data must be the foundation of a provider’s business strategy moving forward. Gathering clean, reliable information from across clinical and financial systems is particularly vital to value-based care success.

With comprehensive information in hand, providers can identify strategies for value-based care success now and later. The insights will give providers a view into their medical cost management practices, as well as the current outcomes of their patients. The data will also help providers predict the trajectory of their costs and outcomes based on current practices.

Providers need data and analytics tools to improve their internal understanding of quality performance at cost. And they are facing growing pressure to communicate clearly to patients where the latter’s dollars are going. Price transparency is important to patients demanding the highest quality of care at the lowest possible costs.

But providers are falling short of meeting this demand. A recent JAMA Internal Medicine study revealed that hospitals are not getting better at providing cost estimates for common procedures. The percentage of hospitals that could provide a cost estimate declined from 48 percent in 2012 to 21 percent in 2016. Delivering accurate cost estimates is a challenge for providers. Merely providing chargemaster prices will fail to give patients the necessary information to compare providers and assess value.

Understanding an individual’s out-of-pocket costs and eligibility for specific services requires data from several sources, including databases not owned by the provider. Without technology that can connect to payer databases in real-time to verify coverage and out-of-pocket costs, providers end up spending valuable time on administrative tasks rather than patient care.

Again, technology can help providers integrate price transparency into their existing workflows to offer value to their patients.

Moving to a data-driven practice begins with clean data. Many of the tools that make up a practice’s IT infrastructure were built with fee-for-service healthcare in mind. A 2018 Quest Diagnostics survey of physicians and health plan executives found that providers do not have access to the tools they need to succeed under value-based arrangements. Providers still need EHRs, clinical decision support, data analytics, and EHR plug-ins or modules, as well as access to comprehensive patient data.

Providers must take a harsh look at their current digital environments, a process that should reveal a glaring need to invest in technologies capable of scrubbing, integrating, and analyzing data from various systems to deliver actionable information to end-users. Time savings are an additional benefit from adopting new technologies and providers are able to dedicate time to new patients or appointments.

Data access and analytics will be the top capabilities providers need to achieve high-value care for all stakeholders. The capabilities not only hold the key to implementing value-based care from clinical and financial standpoints, but also from the patient’s perspective.