It’s still early days for value-based care. The VBC landscape today is characterized by widespread but sometimes superficial adoption. While many health systems have initiated value-based care programs, these efforts, many experts observe, frequently lack the depth, commitment and execution necessary for true business model transformation.
It’s safe to say many health systems are grappling to move beyond traditional fee-for-service models. And it takes an expert in the trenches to make sense of things. Especially the technology side of delivering VBC.
Courtney Fortner is the CEO of Navvis, a company that helps fine-tune major hospitals’ delivery of care around the country. She has a front row seat to how providers are recalibrating their efforts to meet changing patient expectations and the “cash crunch” across the industry.
Navvis uses technology to track how physicians are implementing preventive care strategies with patients. Providers can unlock reimbursement bonuses when benchmarks are hit.
Healthcare IT News sat down with Fortner to discuss the value-based care landscape today, investment in analytics and IT infrastructure to accelerate the transition to the new style of care, strategies to get clinical leaders and individual physicians to buy in and leverage new technology to track key quality metrics, and how technology can be used to compare pricing for healthcare services on a market-by-market basis.
Q. In broad terms, what does the value-based care landscape look like today? And where does healthcare information technology fit in?
A. Here’s what gets me excited: This isn’t just about switching up how we handle the incentives and financial side of healthcare. It’s about radically improving how we care for people – both patients and providers.
The journey toward value-based care is about reimagining patient care delivery to realize better outcomes at lower costs, while also achieving higher patient and physician satisfaction. This transition demands a holistic approach that encompasses clinical, operational and cultural changes within healthcare organizations.
Healthcare information technology plays a pivotal role in this landscape, serving as a critical enabler for the operationalization and scaling of value-based care initiatives. However, it’s crucial to understand that technology alone is not a panacea. The successful implementation of value-based care requires a multifaceted approach that goes beyond simply deploying new software.
It necessitates a comprehensive overhaul of care processes, extensive physician education and training, and a fundamental shift in organizational culture. Moreover, the technology landscape in healthcare extends far beyond electronic health records, encompassing a wide array of tools for population health management, risk stratification, care coordination and patient engagement.
We often observe that health systems and clinicians are overwhelmed by the sheer volume of technology and quality reporting tools at their disposal. This technological inundation can sometimes hinder rather than help the transition to value-based care.
The key lies in strategically selecting and implementing technologies that align with an organization’s specific value-based care objectives, while simultaneously focusing on the human elements of change management.
Successful performance in value-based care are those healthcare organizations that can effectively integrate technology into redesigned care processes, foster a culture of continuous improvement, and empower clinicians with the right tools and insights to deliver high-quality, cost-effective care.
Q. VBC requires some investment in analytics and IT infrastructure to accelerate the transition to the new style of care. Please talk about these tools and practices.
A. We need to think beyond the EHR with respect to technology that supports value-based care and new care models. I talk to a lot of executives at healthcare organizations who look at their EHR and say something to the effect of, “We’ve made significant investments in our EHR, and plan for that to be our platform for value-based care.”
EHRs are clearly a critical tool for what they do, but there are big gaps in EHRs that are crucial for success in value-based care; specifically, capabilities related to financial, clinical and operational analytics as well as care management.
The real challenge with analytics and data isn’t actually the technology itself. It’s making sure all the data from disparate payers and other sources feeds into your system correctly and is readily accessible. Once a set of solid data processes are in place, expertise around analysis interpretation needs to be applied so healthcare organizations can understand key insights.
When data integration is successful, healthcare organizations are able to identify trends and leverage actionable insights for care teams and clinicians to then leverage at the point of care.
These actionable data ultimately have a significant positive impact on patient outcomes. Care teams aren’t just reacting to what’s in front of them – they’re proactively managing patient health, spotting potential health issues before they become problems.
Early disease recognition and being proactive in care management can accelerate the transition to value-based care. It’s not easy, but it’s absolutely worth the effort once you’re able to improve health outcomes across a population.
Q. What are solid strategies to get clinical leaders and individual physicians to buy in and leverage new technology to track key quality metrics?
A. Getting physicians on board with new technology and quality metrics is about approaching any change as a partnership with our physicians. We need to do things with physicians, not to them. It’s not about imposing changes on them; it’s about partnering with them on this journey.
We spend significant time working with physician leadership to help shift the culture from fee-for-service thinking to a value-based mindset. Forging partnerships with the physician team becomes a key success factor to practice transformation. Additionally, much of this transformation work revolves around peer-to-peer physician training.
Ideally, clinical leaders shouldn’t be dealing with new technology or any technology outside of their EHR. The strategy is to provide the care team with additional resources and support to make the transition to value-based care smoother. This includes resources within the practice to review, interpret and act on data insights.
Working with the physicians to help them revamp their workflows within the practice is another key component of transformation, while care team resources actively engage patients and close quality gaps on behalf of the practice.
Another crucial point – we cannot ask physicians to treat different patient populations differently. That’s just not realistic or time-efficient for the physician. Instead, we need to focus on creating a single, streamlined process that works for all patients, regardless of the payment model, payer or population. It is a single approach that an entire care team can follow.
This is where leveraging technology to track quality metrics comes in. We set up systems that automatically collect and analyze data in the background, so physicians don’t have to change how they practice for different patients. It’s about making quality improvement a natural part of their practice, not another item on their to-do list.
Q. How can technology be used to compare pricing for healthcare services on a market-by-market basis? Does AI have a role to play here?
A. If this question refers to pricing with payers, then AI likely does not play a role. Most healthcare organizations are not forthcoming about their pricing. Their contracts with payers likely vary market to market and by population, and they have confidentiality clauses.
If this question refers to healthcare consumer costs, then collecting all claims data for a given patient or across a set of patients can be used to understand per member per month costs – a critical metric in both the fee-for-service and value-based worlds.
Additionally, technology can be used to collect and analyze data to reveal costs for a particular physician, specialist or hospital. When coupled with quality, experience and/or access metrics, these data will show the value provided versus other providers or hospitals. AI could play a role in automating these processes.
Q. How can technology track how physicians are implementing preventive care strategies with patients and unlock reimbursement bonuses when benchmarks are hit?
A. Technology should be leveraged to effectively track and incentivize preventive care. Physicians need a dynamic dashboard that offers real-time insights into their quality measure performance on a patient-by-patient basis.
And then, a system that integrates data from various sources including claims, labs and EHRs, needs to provide daily updates to give providers a clear picture of their standing on each measure, their proximity to bonus thresholds, and identify which patients still have open care gaps. This technology should be designed to be a practical tool for guiding quality care improvements and achieving performance bonuses. User-friendliness is critical to physician adoption.
Again, we do not want physicians to be bogged down with any other technology outside of their EHR. The technology here is more about how the care team can leverage and collaborate with the physician to better manage the patient’s health.
Care team workflows are tied to the financial model (created on the front end) which then informs patient cohort criteria. This ensures that the patients we are engaging and the purpose for which we are engaging them results in unlocking reimbursement bonuses. These bonuses can then be reinvested to continue to enhance how we take care of patients.
Additionally, having a technology platform that can automatically close care gaps when applicable, helps reduce the administrative burden on providers. For scenarios not captured by automated systems, such as community health events, having a straightforward process for manual data entry is important.
Comprehensive patient “face sheets” consolidate all care opportunities in one view, streamlining the care delivery process when physicians are face-to-face with patients in the exam room or on the phone via telehealth.
Having risk stratification tools are also important to help providers identify high-risk patients who may benefit from preventive interventions. All of these capabilities work together to facilitate more targeted and efficient preventive care delivery.
The data captured by this system directly informs the reimbursement model. As providers meet and exceed quality benchmarks, they unlock financial incentives, creating a direct link between care quality and compensation.
This approach fosters a positive feedback loop where improved care leads to better financial outcomes, encouraging continual quality improvements across practices. Tools for tracking total cost of care allow physician organizations to monitor the broader impact of their preventive efforts.
Collectively, these capabilities form an approach to value-based care that aligns the goals of improving patient health at lower costs, with enhanced provider compensation, ultimately promoting a more effective and sustainable healthcare model.
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