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Value-Based Care Tech, Part 1: Provider Infrastructure

The continued success of value-based care depends on providers having the tools they need to collect and analyze data. In the past, those tools haven’t always been up to the task. But that’s changing — and just in time.

Despite the momentum value-based care has seen, one recent HealthEdge survey found that many health insurance executives doubt these programs will grow much over the next two years — and 40 percent cited health care technology challenges as one of the primary reasons why.

Perhaps the biggest obstacle value-based care faces has to do with collecting and crunching data. Providers work most effectively when they’re able to measure changes to patients’ health and identify clues that allow them to prevent — rather than just treat — health concerns. But that’s only achievable when physicians can collect and analyze relevant data, which many can’t.

Fortunately, payers, providers, vendors, academics and others have been working on ways to overcome these challenges. Here’s a look at two interconnected aspects of this health care technology problem: interoperability and analytics.

The Interoperability Hurdle

Patients, especially chronically ill ones, often receive care from several doctors and may visit multiple facilities. Each doctor’s office or facility may have its own electronic health record (EHR) system. In order to share patient information securely, doctors rely on strong communication between these various systems. That’s often impossible when the specialist has one EHR system, the primary care clinic has a different one and the hospital has yet another — even within the same health system. Streamlining the way digital patient information is shared across systems, practices and teams would allow health care providers to increase the efficiency of their care and make more data-driven, clinical decisions.

Think about it: Banks around the world can easily share data with each other, but providers in the same town struggle. It’s difficult for providers — and primary care physicians, your employees’ first line of defense, in particular — to provide whole-patient care if patient data is scattered across various incompatible EHR systems.

Luckily, new innovations indicate that change is on the horizon. Players from outside health care are stepping in with solutions. Apple, for instance, is working with health care organizations to aggregate data in ways that will make it more accessible to both patients and EHRs. And vendor-agnostic EHRs can help health systems connect with practices and other provider organizations, regardless of who built the EHR.

Why this matters: Having all the data in one place helps providers get a full picture of their patients and avoid redundant testing and treatment, controlling costs and improving health outcomes. Interoperability also supports patient engagement and increases individuals’ ability to access and control their health information.

Data Integration and Analytics

In order to provide better population health management, some providers are moving toward EHRs with built-in analytics tools. However, data analytics are only as good as the data itself. And because of an array of issues — including lack of interoperability — few providers are confident they have the data to make decisions that optimize patient care.

Only 39 percent of providers believe they can obtain all the data they need from their EHRs, according to a survey from Quest Diagnostics. Even with a robust EHR, clinical data is only a relatively small portion of the data they need. For example, claims data is an especially rich source of information for identifying high-risk patients and controlling costs — but that data resides with the insurer, and it’s often siloed. Even if providers invest in analytics tools, they risk their efforts being hampered by a shortage of important data. Neither claims data nor EHR data alone can provide a complete, accurate and timely view of a person’s health status, making predictive modeling difficult.

Fortunately, some insurance companies are leveraging their data and tools to make that a reality. For example, Anthem combines its claims data with EHR data and other relevant data sets in a data warehouse. It’s even integrating some patient-generated data.

Why this matters: Providers have a clear picture of the health of their individual patients and patient populations, allowing them to make better decisions — often before the patients get sick. For example, heightened health care provider communication empowers doctors to send carefully targeted information to patients rather than generic messages. Moreover, insurers’ investments in big data analytics offer providers access not only to integrated data, but also to actionable information that can improve care and lower costs without having to make costly investments themselves.

With both interoperability and analytics, it comes down to providers and insurers using data wisely to improve the health of your workers, allowing you and them to control costs.