By The TSquare Team on December 11, 2018 at 11:10 AM
Value-based care has become a hot topic in healthcare over the past several years. But it is no longer just a hypothetical practice or passing trend. The value that value-based care brings is now at a critical mass, becoming reality for many medical practices across the nation.
Writing at Health Affairs, Susan DeVore includes the expansion of value-based care through vertical alignments and mergers as one of the most important things to watch in healthcare. “Given the clear signals, health care leaders are focused on gaining scale and/or vertical integration to position themselves favorably for an expansion of value-based care,” DeVore writes.
The promise of value-based care is there, but its progress may be held up without the right data analytics tools in place. Jeff Lagasse, associate editor at Healthcare Finance, reports that value-based care is stalled in many circumstances by insufficient tools and data. The study Lagasse cites found that than more than half of physicians believe they “do not have the tools to succeed under value-based care.”
In the same study, more than 60 percent of physicians said they think machine learning and data analytics would improve value-based care. The desire is there — but often the tools are not.
For many clinics, data analytics could be that missing piece.
Value-Based Care: The Promise for Clinics and Patients
The concept of value-based care is not new. “Fee-for-value models offer payment based on keeping a patient well, encouraging improvement by emphasizing the outcomes of care and incentivizing providers to improve efficiency—in other words, delivering value rather than delivering fees,” Leroy Jones writes at GSI Health.
With their own data, clinics can define what “value” actually means. “Value, it seems, has become a buzzword; its meaning is often unclear and shifting, depending on who’s setting the agenda,” Robert C. Pendleton, chief medical quality officer at University of Utah Health, writes at Harvard Business Review.
So, let’s aim for a better definition of “value” as it pertains to a patient’s health. “Value-based care is ultimately about getting patients the right care, at the right time, in the right setting, to deliver high-quality, cost-effective care,” says Kate McCarthy at Forrester Research. “Healthcare organizations need to invest in insight platforms and advanced analytics to deliver more effective care and consumer engagement.”
3 Ways Data Analytics Support Value-Based Care
Data analytics can serve as the foundation of value-based care on both the clinical and financial side of things — the high-quality, cost-effective care McCarthy is talking about
Rose Higgins, president, North America, at SCIO Health Analytics, offers a handful of especially interesting use cases for data analytics in healthcare. Each of her ideas would nudge any clinic toward a more value-based model of care delivery.
We want to call out three of those here. These three tactics below would put your clinic well on the road toward value-based healthcare.
1. Understanding the Population Your Clinic Serves
This is the preparation needed to deliver value-based care. Analytics can help you get a better understanding of the population you serve by directly analyzing census data, EHR data and patient communications.
Healthcare consultant Dan Addyson describes the population health approach as healthcare stakeholders attempting to “create better care management solutions that focus less on processing care at point of service and instead keep communities continually healthy and minimize risk before health issues become problematic.”
This is why understanding the population your clinic serves is one of the first steps toward value-based care.
With the right data sources, clinics can better understand patient history, social determinants of health (SDOH) and the health needs of the community as a whole. John Glaser and Dr. Tanuj Gupta at H&HN describe what this can look like. In short, it means consolidating data from SDOH when available, electronic health records, population health management systems, social service resources and community agencies.
It’s not a simple approach, but it’s certainly a worthwhile one.
2. Shoring Up Revenue Cycles
Vera Gruessner at RevCycle Intelligence draws a direct connection between understanding the population your clinic serves and the efficiency of your revenue cycle management. This connection, she says, creates “opportunities to avoid losing revenue in the midst of a value-based care reimbursement model.”
“... Essentially, healthcare providers and hospital revenue cycle managers will need to completely change their methods of assessing the financial health of their establishment. They will need to adopt a new viewpoint in order to see the revenue cycle from the value-based care approach instead of the fee-for-service payment system.”
Data analytics can create that new viewpoint by showing, for example, how actions the clinical and operational teams take directly impact bottom-line profitability.
“That means receiving additional visibility into measures that matter and confirming which day-to-day working measurements will help signal the impact of frontline care on revenues,” George Dealy, VP of healthcare applications at Dimensional Insight, tells Gruessner. “The most important element is receiving direction from leadership that gets everyone on the same page.”
3. Laying the Groundwork for Personalized Care
If one of the goals of value-based care is to standardize best practices (and improve efficiency for the clinic in the process), data insights bring better information to simultaneously standardize and personalize the decision-making process.
A “system of insights” will let healthcare organizations see complicated, disparate data in a clearer light, Bill Siwicki writes at Healthcare IT News. In other words, true value-based care would be impossible without the data analytics to support it.
Not only that, but Siwicki points out that good data analytics in light of value-based care also requires a system that brings EHR, financial and external data all together. By bringing this data together, clinics can provide more personalized care to different segments of the population they are serving.
The bottom line? Both clinical and financial data are indispensable as clinics begin to build value-based care systems.
“What providers absolutely must have are really powerful analytics that are able to take clinical and outcomes data, a lot of which resides in clinical systems, and combine it with financial data to accurately measure where we improve quality based on outcomes results,” says Deanna Kasim, research director of payer health IT at IDC Health Insights.
Putting analytics in place can help clinics understand their patients, provide optimal and personalized care options and make their practice more efficient in the process.
The Takeaway: Data as the Foundation of Modern Medical Clinics
True value-based care would be impossible without data analytics. “As we move closer toward value-based care, analytics become even more important, along with the ability to bring in clinical information to support the revenue cycle,” says Kellye Sherbet of Aprima Medical Software. The result benefits the medical clinic as much as it does the patient.
With data analytics in place for medical clinics, value-based care is not out of reach. This post has highlighted why data serves as the foundation of future medical clinics. Now, it’s a matter of how.
Images by: rawpixel