As the healthcare landscape continues to shift from the traditional fee-for-service reimbursement model to a value-based care model, there is an increasing emphasis on improving patient outcomes, quality, and reducing cost. While an accountable, value-based approach to care offers myriad benefits for all parties involved, the transition is not always an easy one. The shift to a more accountable approach to healthcare requires coordination and connectivity among multiple providers, hospitals, and health plans in a way that has never before been required.
Technology plays a critical role in this coordination. The following are solutions to three technological challenges commonly faced by medical practices today as they move from volume to value.
Challenge #1: Cost of Necessary Technological Infrastructure
A successful accountable, value-based model relies on a primary-care physician to coordinate a patient's care among all involved providers. However, providers often use different EHR systems, and implementing the necessary infrastructure to allow data and information sharing among different providers poses a significant financial burden. This can be an enormous obstacle on the pathway from volume to value.
Solution: Providers can benefit from the investments payers have already made in emerging Health Information Exchange (HIE) technology to support the infrastructure needs of provider practices. HIE solutions were created to support the provider's needs for real-time data sharing and analytics to bridge the divide across the many EHR platforms in use today.
Challenge #2: Lack of Access to Clinical Data
In a coordinated care approach, all providers involved in patient care need access to a patient's full medical history to understand gaps in care, medications taken, and clinical reports. Access to clinical data is a key component for improving patient outcomes and successfully managing population health. It also reduces or eliminates the need for onsite chart access, chart retrieval from other providers, and chart copies.
Solution: Payers offer robust clinical care integration and care management capabilities and tools, such as predictive analytics, real-time identification of gaps in care, and clinical alerts. These tools give providers the full picture of their patients' health status and needs, helping them to provide the best possible care for each patient.
Challenge #3: Burdens and Complexities of Value-Based Program Reporting
The accountable care model requires providers to adhere to clinical standards, quality measurements, and financial measurements for the total patient population they are managing in order to earn reimbursement from value-based programs. This work can be overwhelming for providers and practice staff, already facing tremendous time constraints and rightly viewing patient care as their first priority. However, administrative tasks like ensuring appropriate and accurate coding, ensuring delivery of care at the most efficient and clinically appropriate site, and complying with other requirements of value-based programs are critical to a provider's overall success.
Solution: Emerging innovations in practice management tools for population health management are now available to help support providers and office administrators. Management service organizations and some payers offer reporting tools that can help providers capitalize on opportunities for improved management of their patient population, making it easier for providers to focus on their patients.
Accountable care is the way of the future, but getting there is not without its difficulties. There are a number of emerging tools and resources to help providers successfully navigate this new territory and maintain focus on their number one priority: patient care.
Chip Howard is market vice president and payment innovation leader for Humana. E-mail him here .