Value-based care (VBC) is a fundamental shift from volume-based, fee-for-service models to outcome-driven healthcare delivery. It characteristically requires providers to be far more dynamic about patient care, assessing risk and working collaboratively with other providers for individual patient-centered goals. However, at its full extent, this ask of providers is likely beyond what the average health organization technology stack can facilitate.
VBC providers must manage risk, improve patient outcomes, reduce costs, and demonstrate measurable value. All the while, the VBC landscape is actively evolving, making it a critical strategic imperative for VBC-enabling platforms to be run on modular, interoperable tech stacks that allow organizations to adapt, grow and thrive.
Working toward a sustainable VBC model isn’t just about clinical skill or payer incentive; it hinges on the ability of healthtech leaders to build foundations that are sophisticated, efficient, and integrated to best enable its provider end users well into the future of VBC.
Core Components of a Resilient VBC Stack
A shift to value-based care requires a robust and interconnected technology ecosystem to support careful risk measurement and dynamic decision making for providers that can take several traditionally disparate parts of a patient’s care journey into consideration without burdening the provider with extra steps and variations in workflow.
Platforms that allow providers to move beyond episodic, siloed care and embrace a holistic, data-driven approach with ease do so by carefully integrating seven core components, starting with the EHR system. When these systems are designed to work together, they create a powerful engine for improving outcomes, coordinating care, and engaging patients, which is the very essence of value-based care.
- Electronic Health Records (EHR): A foundational data repository in today’s healthcare world, the integration of an EHR system is a clear necessity for any provider platform. Patient care decisions simply cannot be made without a complete, accurate, and easily accessible record of their health history. These patient records should be available to every provider and clinician serving a patient.
- Population Health Management: When integrated into a VBC-enabled platform, population health tools can proactively identify high-risk individuals and flag at-risk patients to providers who can initiate the necessary assessments or precautions. This closes care gaps and prevents costly health crises before they happen.
- Data Analytics and Business Intelligence: Robust analytic capabilities and real-time dashboards allow organizations to track performance against key VBC metrics that can identify patient trends, understand cost drivers, and help clinicians make informed decisions that improve efficiency and outcomes.
- Care Coordination and Patient Engagement: Patient success in a VBC model depends on a team-based approach, thus care coordination systems must enable seamless communication and information sharing between different providers to ensure a patient’s care is consistent and well-managed across various settings. Patients themselves should be considered a part of that care team, which is exactly how patient engagement tools should factor in. Patients who are empowered to take an active role in their health often experience more positive health outcomes.
- Clinical Decision Support: VBC is a long game, and clinical best practices are updated often. This means that patient care recommendations should not be stagnant over time. New evidence-based recommendations must be offered to clinicians at the point of care to reduce human errors, improve adherence to clinical guidelines, and ensure that every decision is aligned with the most up-to-date information.
- Health Information Exchange (HIE): HIEs are the critical bridge that allow for the secure, longitudinal sharing of patient data – a key piece of the VBC puzzle that reduces redundancies in interdisciplinary care plans and gives providers the full patient picture they need to make the right decisions at the right time.
- Telehealth and Remote Patient Monitoring (RPM): Telehealth capabilities help to ensure patients’ lives are minimally disrupted, while integrated RPM with AI-enabled early detection enables providers to continuously monitor patients with chronic conditions directly within their platform while they’re out living their lives. Both provide convenience and reduce costs while still enabling timely interventions as needed.
While the backend tech stack is complex, the provider’s experience must become simple and intuitive, allowing providers to get the relevant data they need, at the right time, without sifting through multiple applications, ultimately enabling them to focus on what matters most: patient care. In practice, this could manifest as critical lab data popping up on a physician’s screen to flag a potential condition, or prompt the physician to order a follow-up lab or referral. Relevant public health data may appear in the corner of a patient’s chart, alongside future appointments with allied providers for full team visibility. This sort of workflow ease can only be achieved through systems that have an integration first mindset and a modular architecture that allow health tech to adjust, upgrade, and swap out components when needed to enhance the provider’s usability.
Common Implementation Challenges
Working toward more complex systems inherently involves roadblocks. Challenges common to VBC may arise in data integration, security and compliance, budgetary constraints, and even human aspects of change management, and should be carefully considered. While these challenges may not be new to health tech professionals, the approach to resolving them with a VBC-enabling result may be.
- Data Integration and Interoperability: Broadly, data integration and ensuring interoperability of several core components and disparate platforms will involve highly detailed and time-consuming work, however seamlessness will be crucial to provider adoption and patient outcomes.
- Security and Compliance: All healthcare technology platforms must ensure the protection of patient health information and adhere to regulations like HIPAA. With each integrated layer adding more complexity and interoperability into a VBC-enabled platform, so too do security needs become more complex.
- Cost Management: Building a sustainable VBC-enabled platform can be a significant investment of time and resources, but a well-integrated system will ultimately reduce long-term operational costs.
- Change Management and Provider Adoption: VBC is a different, more personalized approach to patient care. In the same vein, new technology platforms to support VBC will mean new clinical workflows. The whole provider organization must be aligned in patient care goals.
A VBC Priority
It is critical to reduce the burden of all of these systems for providers to be successful in value-based care models. Ultimately, providers must have a single avenue through which they manage all workflows and patient care, where common challenges are obfuscated, and timely patient needs are moved forward with ease.
Providers have a tremendous number of shifting priorities. It is the responsibility of technology leaders to reduce that burden so that they can get the relevant data they need in the right place at the right time. Organizations that can successfully piece this puzzle together will be the ones that drive the healthcare industry towards a sustainable value-based future.
About Ron Margalit
Ron Margalit is the Chief Information Officer of Evergreen Nephrology. With over 15 years of executive leadership in healthcare technology, Ron develops business strategies fueled by competitive advantages and has a history of architecting high-return, scalable technology solutions in value-based care while balancing security, continuity, and compliance. He has created numerous proprietary IT solutions to meet the security, workflow, and process needs of multiple healthcare providers that reduce spending while driving growth.
