By Josh Hetler, Executive Vice President, Sales & Marketing
Published by: Today’s Geriatric Medicine
The COVID-19 pandemic has sent shock waves across the entire health care ecosystem, presenting significant challenges for geriatricians and other health care professionals struggling to provide the best possible care for the nation’s older adults during this difficult time. On the clinical side, providers must deal with frequent infections in older people, higher disease severity, and increased mortality impeding implementation of appropriate preventive measures and future strategies to protect against this disease.
Additionally, poor health status, weak immune function, lowered organ function, increased probability of multiple underlying diseases, and poor attention to personal health among older adults often increase the susceptibility to various other diseases. Reflecting this national trend, the Medicare Advantage (MA) program is growing rapidly. From 2008 to 2018, the proportion of Medicare beneficiaries enrolled in MA plans increased from 21% to 34%. In this environment, geriatricians will play an increasingly vital role, making assessments to address the clinical complexity in this population to increase the potential for these individuals to live more safely and independently—despite the risks associated with disease and age.
Other considerations involve the need for providers and health systems to seek strategies for remaining financially viable in response to the precipitous drop in elective and other nonessential care due to the COVID-19 pandemic. As many hospitals and private practices struggle financially, the limitations of fee-for-service models have never been more evident. Industry experts believe that, post pandemic, the gradual shift toward a larger share of patient care organization revenues coming from value-based contracts will continue.
Many see promise in population health solutions that emphasize value-based care, in which providers receive payments based on measures, such as quality, efficiency, cost, and positive clinical outcomes from private payers or government programs. This approach takes the long view to care—from the initial provider visit to months or years into the future. As a result, providers are incentivized to focus on long-term outcomes and the costs of a treatment and finding innovative approaches for containing costs and enhancing outcomes.
This is significant because approximately 80% of older adults have at least one chronic disease, and 77% have at least two. Four chronic diseases—heart disease, cancer, stroke, and diabetes—cause almost two-thirds of all deaths each year. Chronic diseases account for 75% of what the nation spends on health care, yet only 1% of health dollars are spent on public efforts to improve overall health.
Given all these factors, stakeholder alignment is critical for value-based care, especially with payers that focus on the cost and impact on population health. Geriatricians and other providers making this shift are moving carefully and thoughtfully, building systems that encompass quality benchmarks and risk adjustment rules.
Focus on Data
It’s become critically important for health systems to adopt effective tools that will enable providers to identify care gaps, access data that informs clinical decisions, improve quality and risk adjustment scores, and enhance patient outcomes. The challenge is that data required for understanding the quality of the care being delivered to patients during this time has been largely unavailable.
Consequently, this essential information to help clinicians improve care delivery for older patients is not easily available. This further demonstrates how the typical approach to quality and safety measurement is too labor intensive, frequently causing significant data delays and lacking adequate standardization for rapid data sharing. The ability to systematically collect information from providers or patients can improve assessment of care quality while improving provider performance, treatment outcomes, and efficiency.
In the early days of the pandemic, it became obvious that measuring quality across the US health care system would not be practical. Therefore, the Centers for Medicare & Medicaid Services granted broad exceptions for collecting and submitting data for Medicare quality programs. Citing the need for hospitals and clinicians to focus instead on a possible surge of patients, they suggested that data from the first six months of 2020 should not be used in any of the current hospital-based performance or payment programs or from other quality reporting organizations.
The pandemic environment has also underscored how quality measurements fail to provide information that can aid in the decision-making process at the point of care—where it’s needed most. In fact, 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. Also, non–claims-based measures, such as hospital-acquired infection measures, have long delays, rendering the information irrelevant. When feedback is not timely, it becomes less actionable and, during a health crisis, the delay is amplified, eliminating an important window of opportunity to learn and improve.
During the pandemic, quality measures also fail to have sufficient data standardization for the purposes of data sharing. The ability for health systems to compare performance data is essential for delivering the best possible care to elderly populations. Defined performance measures that could help to understand how, for example, telehealth has affected the quality of care delivered to patients is nonexistent. Access to a rapid tool for identifying and disseminating a standardized way of collecting data about new types of clinical information enables providers to better understand and improve performance.
HEDIS Measurement Reporting
Healthcare Effectiveness Data and Information Set (HEDIS) measures are used by 90% of health plans in the country for health care performance measurement. Such measures are vital for the overall health care system because they ensure that payers are collecting and analyzing data related to performance. In fact, a number of payers have turned to value-based reimbursement models to help meet HEDIS benchmarks.
Here too, the pandemic has affected data collection activity. The newly released guidance eliminates the requirement for MA plans to submit HEDIS 2020 data (for 2019 dates of service) because of the burden placed on health care workers. Instead, the Centers for Medicare & Medicaid Services says it will use last year’s performance (measure-level rates and ratings, based on 2018 performance) for the 2021 Star ratings.
Finding an Effective Technology Partner
Finding the right technology partner can lead to better outcomes using real-time data aggregation, electronic health record (EHR) connectivity, dynamic dashboards, and quality reporting. An optimal point-of-care solution effectively identifies open care gaps for proactive closure and provides payer-agnostic data to inform clinical, quality and risk adjustment programs for improvements in quality, risk adjustment scores, and patient outcomes.
Geriatricians should find a solution with a robust HEDIS engine that is certified by the National Committee for Quality Assurance for all measures and refreshed annually for the most accurate data. The solution should be designed to facilitate the transition to value-based care by meeting the need for a complete interoperable population health management solution that aligns the payer, provider, and patient with one solution that proactively closes care gaps, ensures visibility into the patient’s complete health status, and manages utilization to facilitate better care planning and improved health outcomes.
Beneficial quality management capabilities include the following:
• uses analytics to prioritize patient populations;
• harnesses EHRs to reduce reporting lag;
• provides EHR extraction and data standardization using Continuity of Care Documents;
• uses telehealth to drive care delivery;
• generates patient and provider scorecards; and
• improves provider engagement and incentives.
The technology solution should also offer real-time data insights captured from disparate sources, allowing 360-degree visibility into the patient’s health status based on information from EHRs, health information exchanges, claims, labs, pharmacy, and hospital sources.
Through the aggregation of data, 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 inclusion of supplemental data, such as a retinal eye exam or blood pressure measurement, provides additional clinical information about a patient for a more comprehensive picture of the care and services delivered.
For now—and into the future—effective value-based care approaches must extract meaningful data and technology applications to efficiently manage patient-centric care that results in improved outcomes and lower costs. A value-based model with high-touch, prevention-focused care is about providing more care that is holistic now to prevent the need for far more expensive care down the road. The result is better outcomes for the nation’s older patients and a better financial situation for primary care providers.
The COVID-19 pandemic has revealed critical challenges related to quality measurement. Implementing the recommendations for improvement will require a higher level of planning and coordination—because the risks of failing to do so are significant.