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Cracking the Data Behind Value-Based Care

Patient data in health care is at the center of value-based health care. This payment model compensates providers based on the value of their work rather than the volume of it.

But to do their jobs effectively, providers need timely access to accurate data, since that information influences which tests and treatments they prescribe for their patients. Because patient data can include intimate personal details, though, it also has to be stored securely to prevent those details from getting into the hands of unauthorized users.

These elements — access, accuracy and safety — ensure providers have the resources to deliver efficient, high-quality medical care for patients. Here’s how each contributes to a strong data ecosystem.

Accessibility

Patient data in health care comes from many sources over time, including prescriptions, lab tests, diagnostic images, genetic tests, surgeries, providers’ notes and other records.

To be useful, though, this raw data needs to be aggregated and made accessible to providers in addition to patients. For example, a primary care provider and medical specialist may need access to a patient’s medical records to coordinate the routine blood tests, medications, eye exams, nutrition counseling and other services involved in caring for their diabetes.

Providers often join health information exchanges to make data-sharing easier to do. For example, OnePartner Health Information Exchange aggregates data for 95% of patient-provider encounters in certain areas of Tennessee and Virginia. Tapping into this data gives the region’s providers a comprehensive view of their patients’ medical histories. Holston Medical Group’s providers used this data to reduce hospital admissions and emergency department visits. Their work led to higher reimbursement on value-based contracts with payers.

Accuracy

Inaccurate data in health care settings can lead providers to prescribe the wrong procedures or medications, potentially putting patients in harm’s way.

Say a patient’s electronic medical record shows a past history of pulmonary embolisms, which are blockages in the lungs. Their physician orders a CT scan to find out if they have a new blockage. However, the provider who originally used the abbreviation “PE” in the record wasn’t referring to a pulmonary embolism but a physical exam.

How does this happen? One way is through the use of copy-and-paste functionality in electronic medical records. Physicians spend a lot of time each day documenting their work; when they don’t review the copied information, they may not catch errors.

To solve this problem, health systems are working to reduce the documentation burden on providers and share it more equitably among care teams. For example, some documentation responsibilities, such as reviewing current medications with patients, may shift from physicians to nurses or medical assistants.

Security

Cyberattacks on health care organizations have become nearly commonplace. There have been 2,546 health care data breaches involving more than 500 records between 2009-2018, exposing the personal information of more than 59% of the U.S. population.

For value-based health care to flourish, providers and patients need to trust that private medical data is stored securely enough to stay private, even in the face of unlawful activity. Otherwise, they’ll be wary about using it.

Hospitals, medical groups and other providers are implementing numerous solutions to mitigate this problem, including:

  • Two-factor authentication. This is a process that goes a step beyond user names and passwords by adding a unique source of identification, such as a fingerprint scan or text message to a mobile phone.
  • Role-based access. With this safeguard in place, employees only see the information they need to do their jobs.
  • Scan and audit logs. These logs track who viewed what and when they did it.
  • Staff training. Everyone on staff should learn to recognize phishing attacks on email systems.

Value-based care has real potential to raise the value of the care that patients receive every day, but only if the right building blocks are in place. Accessible, accurate and secure patient data in health care is an essential precursor to the widespread adoption of value-based operating models — and one that providers, insurers and other health will continue to work toward with imaginative ways of delivering care and innovative strategies for improving the entire patient experience.