By Josh Hetler, Executive Vice President, Sales & Marketing
Published by: DOTmed News
The COVID-19 pandemic has left many hospitals and private physician practices struggling financially, and underscored what academic and health policy experts have said about fee-for-service (FFS): it is inefficient and incentivizes providers to do more than necessary to increase revenue.
The FFS model rewards the most expensive interventions, at the cost of preventive care, behavioral health services and disease management. What’s more, FFS fosters a siloed health care system that cannot support care coordination across providers.
The pandemic has also compromised quality reporting and HEDIS measurement reporting, demonstrating how the current approach to quality and safety measures remains too labor intensive, often causing substantial data delays and lacking sufficient standardization to allow for rapid data sharing. All of these factors have prompted a shift toward value-based care.
To help with this shift and offset potential profit decline, stakeholders should consider partnering with a healthcare technology company that offers expertise in population health and experience in empowering better outcomes using real-time data aggregation, EHR and health information exchange (HIE) connectivity and quality reporting through dynamic data visualization.
A clinical data connectivity solution can improve operational performance, care delivery and patient outcomes so that providers can effectively measure the quality of care they are providing. As payers focus more on the cost and impact on population health and assume accountability for delivering better patient outcomes at a lower overall price, stakeholder alignment will become that much more critical in the expanding value-based care environment.
Improving quality measurement and reporting
For providers, adopting effective tools can help them to identify care gaps, access data that informs clinical decisions, improve quality and risk adjustment scores and enhance patient outcomes. In recent months, however, the data required for understanding the quality of the care being delivered to patients during this pandemic has been largely absent.
In fact, the current approach to quality measurement has caused substantial data delays and lacks sufficient standardization to allow for rapid data sharing. Payers need to have the ability to systematically collect information from providers or patients to effectively assess the quality of care provided to improve performance, treatment outcomes and efficiency.
To be effective, quality measurements must be available at the point of care to better inform decision making. Many claims-based quality measures, such as the Patient Safety Indicators, have a 12-month lag between the end of the care delivery period and the reporting to hospitals on their performance. Non–claims-based measures, such as hospital-acquired infection measures, also have long delays, making the information less actionable. For feedback to work it must be timely and provide an opportunity to learn and improve.
At the moment, defined performance measures are non-existent. Access to a rapid tool for identifying and disseminating a standardized way of collecting data about new types of clinical information, however, could enable health systems to understand and improve performance.
In another important area, Healthcare Effectiveness Data and Information Set (HEDIS) measures, which are used by 90% of health plans in the country for health care performance measurement, can ensure that payers are collecting and analyzing data as it relates to their performance. In fact, a number of payers started using value-based reimbursement models to help meet HEDIS benchmarks.
The newly released guidance eliminates the requirement for Medicare Advantage (MA) plans to submit HEDIS 2020 data (for 2019 dates of service), because of the burden placed on health care workers. Instead, CMS will use last year’s performance (measure-level rates and ratings, based on 2018 performance) for the 2021 Star ratings.
Choosing an effective clinical data connectivity solution
It’s important to find a point-of-care solution that can effectively identify open care gaps for proactive closure and provide payer-agnostic data to inform clinical, quality and risk adjustment programs for improvements in quality, risk adjustment scores and patient outcomes.
Stakeholders should also seek a solution with a robust HEDIS engine that is certified by the National Committee for Quality Assurance (NCQA) for all measures and refreshed annually for the most accurate data. This type of solution is critical for facilitating the transition to value-based care because it can meet the need for a complete interoperable clinical data connectivity solution that aligns the payer, provider and patient in a way that proactively closes care gaps, ensures visibility into the patient’s complete health status and manages utilization to foster better care planning and improve health outcomes.
With the aggregation of data from EHRs, HIEs, claims, labs, pharmacy and hospital sources, users gain transparency at the patient-level and provider-level through real-time data visualization that drives collaboration opportunities to break down departmental silos across the organization.
The best value-based care harnesses meaningful data and technology solutions to efficiently manage patient-centric care that leads to improved outcomes and lower costs. Bottom line: a value-based model with high-touch, prevention-focused care can provide a holistic view of the patient now that prevents the need for far more expensive care later.