One strategy for shifting to value-based care: Get IT right
One health provider has a plan for succeeding in a value-based care world and it starts with a strong IT framework. This week at the Pop Health Forum in Boston, industry insiders met to discuss and share ideas surrounding population health. Naturally, a big topic of discussion was the transition to value-based care as hospitals and health systems think about how to navigate in a post-fee-for-service world.
Yet for all the talk of switching toward value, it isn't clear how ready the industry actually is. Scott Monroe, director of commercialization of data informatics at 3M, shared results from a 3M study that found 85% of healthcare organizations reported less than a quarter of their operations are designed to maximize value-based care. While there is no crystal ball on what will actually happen, the CMS has a goal of tying 50% of Medicare fee-for-service payments to alternative payment models (APMs) in 2018. While some believe APMs will evolve, the 3M results show that it could be hard to get to CMS' intended goal. To be fair, the agency did reach it's goal of tying 30% of Medicare payments to APMs last year early on.
So once a provider decides to actively move to a value-based care (VBC) framework, where does one start? For UMass Memorial Healthcare, one of the key components to establishing such a framework is building a solid foundation composed of IT and data infrastructure. "IT is an enabler and you have to look at it that way," Dr. Thomas Scornavacca, senior medical director at UMass Memorial Healthcare, told Healthcare Dive at the conference. "It enables the network development and clinical work you need to be successful in population health."
How IT matters in a VBC world
During their presentation, Renee Broadbent, AVP, population health IT and strategy at UMass Memorial Healthcare, pointed out that an IT infrastructure will be necessary to succeed under MACRA, whether a provider chooses a MIPS or APM track. In addition, it can help with enhanced reporting and data analytics to create actionable items to manage patients and populations.
When looking for an IT foundation to support a VBC framework, Broadbent told Healthcare Dive she wanted the infrastructure to be flexible to be able to adapt over time as needs change. UMass is rolling out an Epic EHR set to go live on Oct. 1, but the system is also implementing a data aggregation strategy across a variety of tools. For Broadbent, data aggregation is a two-fold effort. For one, an aggregation tool can stand the test of time whether it's embedded into an EMR, part of another package or it's a standalone agnostic tool, what UMass went with. "We wanted to be agnostic because some of the things you run into with...pulling data from other vendors is IP issues then everybody starts to not cooperate as much. So I wanted something in the middle that didn't care if we were freestanding [and] had no skin in the game on either side except to honor their contract," Broadbent said.
"[IT] enables the network development and clinical work you need to be successful in population health."
Senior Medical Director, UMass Memorial Healthcare
The other piece for aggregation is organizational. An Epic rollout isn't a type of IT buy that organizations just check out for fun and then throw away in three years. From a population health perspective, external data can be integrated into the Epic system. What will change is data management and collecting as regulations change. "This is my plan for the next three years and that is based upon the current regulatory environment and Epic's timeline so the aggregator we selected is good for three years," she said. "We constantly will evolve that strategy as time goes on, 12 months, 18 months and any organization that is proactive would do that."
The presenters noted they built an Office of Clinical Integration comprised of coders, practice improvement facilitators, outreach support and more to help deliver actionable data such as point of care reminders and transparent performance reporting to providers. "The whole point of all of this is to make sure the physicians can spend their license and time seeing patients," Scornavacca told Healthcare Dive. "That's where all of this has got to go."
Building for IT flexibility
"You have to get comfortable with this," Broadbent told Healthcare Dive. "Epic isn't going to solve all problems. The conceptual model is what your premises are for population health data reporting, care management and the data elements you need to get that information." In other words, organizations need to decide what tools are going to comprise their population health in addition to their EMR after deciding what they are trying to accomplish. "You're trying to meet the needs of the network," Scornavacca said.
Broadbent adds that as long as you can decide what's important, narrowing down IT systems should come naturally. But the presenters noted that a population health strategy should be defined by more heavily investing in technology. "This is a great space to be in now," she said. "We've seen a lot of innovations in technology in the last five years in this space. Much like the EHR market, in a few years it will streamline a little bit and there will probably be some good integrated tools that can maybe get smaller venues into the market to manage population health."
And there's plenty of room for vendors to get into the health systems currently, according to HIMSS Analytics Director of Research Brendan Fitzgerald. During his "Trends in Population Health" presentation, he cited HIMSS Analytics survey results which found 66% of hospitals have yet to purchase a pop health tool.
Data interoperability is going to become front and center because it's going to focus on getting data to the patient so they can make actionable decisions about their own care."
Population Health IT and Strategy, UMass Memorial Healthcare
No one said it would be easy
However, both Broadbent and Scornavacca know there can be integration challenges. On the provider's end, if data aren't placed in the correct data fields, the wrong workflows can be noted in the EMR so you can start to enter what Scornavacca calls "a world of workarounds." If all providers develop their own workarounds, data doesn't reside in the same place making the act of pulling that data frustrating.
"Providers are willing to do this if they know they're going to get actionable data in return" and a standardized document can help with knowing where data are in reports to make actionable decisions. Not only are easy-to-read documents helpful for physicians but Broadbent notes the trend toward consumerism and patient experience also makes it important for patients to get their health data in their hands. "Data interoperability . . . is going to become front and center because it's going to focus on getting data to the patient so they can make actionable decisions about their own care, their providers and where they want to get care. You're going to see that transition and the best thing you want to do right now is create a fluid strategy from a technology perspective by picking those agnostic solutions," she said.
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