The famous quote “What gets measured, gets managed” is often incorrectly attributed to business guru Peter Drucker. Although Drucker may not believe that maxim entirely, when it comes to value-based care (VBC), only care quality that can be measured and reported matters.
Whether it is capitated, bundled, pay-for-performance, or hybrid VBC reimbursement models, the Centers for Medicare and Medicaid Services (CMS) and other payers typically have significant demands regarding quantitative data reporting on care quality, outcomes and costs. To ensure that an organization is achieving those clinical and financial goals, providers and administrators must be able to share data from across the enterprise fluidly, and easily determine performance through dashboards and other highly interpretable methods.
Too many health systems, however, still have structured and unstructured data scattered in different siloes rather than a digital IT infrastructure that leaders can leverage to measure performance and adjust clinician behaviors and operational strategies.
As VBC payment models continue to gain traction, health system leaders are realizing that digitizing and integrating all data holistically can deliver that needed comprehensive view of patients that enables actionable insights, allowing payers and providers to reduce costs and improve care quality under VBC contracts.
VBC Adoption Accelerating
Given the budgetary challenges that many health systems are facing, it is not surprising that leading health systems that can demonstrate superior clinical and cost outcomes are gravitating toward VBC programs, and payers likewise are expanding such alternative-payment structures.
Consulting firm McKinsey forecasts in a report that the number of patients treated by physicians under VBC payment models could roughly double in the next five years, growing approximately 15% per year. More recently, Bain & Company wrote that VBC “stakeholders are doubling down on their commitment,” noting that healthcare spending is gaining steady momentum after the COVID-19-related destabilization. As a result of spending expected to outpace the GDP in the foreseeable future, Bain expects VBC adoption momentum to accelerate.
Unifying the Enterprise Through Digitization
To take full advantage of the data needed to drive value-based arrangements, many healthcare organizations need to overcome several obstacles associated with the unique and messy nature of healthcare data.
For example, as much as 80% of healthcare data is unstructured, according to some industry estimates, such as images, audio, video, clinical notes, scanned documents, faxes and freeform text. Since this information is rarely digitized and combined with other forms of data sets, it is rarely leveraged to yield actionable insights to improve VBC performance.
Likewise, the disparate forms of information across enterprises also infrequently adhere to healthcare-industry data standards – such as HL7, x12 EDI, FHIR, NCPDP, CCLF, and CCDA. Even worse, data standards frequently are nonexistent for many patient data sets, such as those from devices, wearables, and social determinants of health (SDoH).
Data silos do not only exist within organizations either. External data sets (such as those maintained by community-based organizations and government entities) are often absent from health system’s VBC-driven assessments. This is unfortunate because such external data can provide a 360-degree view of the patient that allows healthcare organizations to identify and proactively address SDoH-related issues and other factors that impact access to care.
Disparate data sets mean healthcare organizations are often unable to create and access patients’ longitudinal health records across systems or payment information in real-time. This can undermine point-of-care decision-making and lead to delays in the revenue cycle.
The Expanding Role for Emerging Technologies
Fortunately, artificial intelligence (AI) technologies are now utilized across healthcare to digitize data and reduce errors. AI helps automate tasks and decision-making processes while facilitating bidirectional integration between information systems.
AI-based technologies such as natural language processing (NLP) and computer vision can drive data digitization by converting unstructured information from notes and images into structured data that can inform care delivery and coordination. ML algorithms also can help reduce claims denials by improving error detection in billing and coding. Further, AI and ML tools accelerate the processing of large data sets, helping to inform precise and comprehensive value-based risk forecasting and providing recommended actions to improve patient outcomes.
These emerging technologies are an essential element of a VBC-oriented data infrastructure that automatically processes standard, non-standard, and external data sets and uses an Enterprise Master Patient Index algorithm to tie disparate patient data records into a unified patient record.
In addition, utilizing APIs, DaaS (Data as a Service), Platform as a Service (PaaS) and Software as a Service (SaaS) models, combined with a modern application stack, will help provider and payer organizations digitize data, synthesize different types of data sources, identify errors, and seamlessly integrate new data sources.
Making the Data Deliver Value
Too often, providers and administrators spend more time searching for, reviewing, cleaning and reporting the data required for VBC program compliance instead of delivering high-quality care. By successfully evolving to a data management strategy focused on automatically digitizing, standardizing and unifying data, health systems can enable easy access to accurate, comprehensive, and up-to-date longitudinal patient records.
As a result, their providers and administrators can instead spend more of their time on high-quality care delivery associated with optimal outcomes for patients and lower costs for providers and payers.
About Rahul Sharma
Rahul Sharma is the CEO of HSBlox, an Atlanta-based technology company empowering healthcare organizations with the tools and support to deliver value-based care (VBC), successfully and sustainably.
