Like it or not, value-based care (VBC) is expected to account for 59 percent of healthcare payments by 2020, according to the Aetna 2018 Health Care Trends Report.
This means physicians will have to continue to do more with less: Every patient experience will need to support the Triple Aim goals of quality care under the Centers for Medicare & Medicaid Services (CMS), including improved patient outcomes and lowered costs. Physician practices that can’t demonstrate high-quality, cost-efficient care may face steep financial penalties.
This is a daunting, onerous task for physicians, especially because existing communications technology may not adequately support Triple Aim goals. Electronic health records (EHRs) were supposed to support VBC by providing technology that enables primary care physicians to coordinate care across the continuum but many, if not most, EHRs don’t live up to the hype.
A recent JAMIA study revealed EHR use is still slowing physicians down, making them less productive and impacting the patient experience. As the American Academy of Family Physicians (AAFP) noted in a letter to the Office of the National Coordinator for Health Information Technology (ONC) in January, “Gaps in EHR functionality to support primary care practices are widening with the additional requirements of value-based payment models.”
Therefore, as we move deeper into VBC, we must consider the extent to which our existing medical documentation and data-exchange technology — especially our EHRs — are helping physician practices improve productivity and support collaborative relationships among care teams. EHRs should be part of the solution, not the problem.
EHR woes in a VBC world
As the AAFP suggests, physicians need EHRs to do more. It isn’t enough that we’ve achieved technical interoperability. We need seamless care transitions. We need care coordination, executed with the finesse of an Olympic runner handing off a baton in the 400-meter relay.
Consider CMS’ 2018 Psychiatric Collaborative Care Model (CoCM), which offers reimbursement to primary care providers who coordinate care effectively with behavioral health providers. The model requires a high level of teamwork from providers in different settings. On the surface, this seems easy enough.
But if an EHR isn’t easy to navigate and information isn’t easy to share, care partners won’t have access to the data they need to support the patient. So, for example, if a patient misses a dose of medication or a psychiatrist doesn’t report that a drug-addicted patient relapsed, the primary care physician could unknowingly prescribe the wrong medication, and the patient could end up in the emergency department.
If care partners can’t or won’t “talk” to each other through their communications technology system — pushing time-sensitive information in real time, documenting changes in medication, reporting new interventions or patient progress — they are undermining care. And even one weak care partner link in an accountable care organization (ACO) can derail patient progress and financial incentives.