Unlocking the Future of Value-Based Care With Data

October 16, 2023 - Advocate Health is a value-based care leader. More than 2.4 million lives are covered by the health system’s value-based care contracts, which include 12 different accountable care organizations (ACOs) and clinically integrated networks (CINs). Moreover, some of those ACOs recently generated $128.2 million in total savings for the Medicare Shared Savings Program, the most in the country among integrated delivery networks.

Advocate has operated in the value-based world — and found success — for nearly two decades through various contracts. Yet, the healthcare industry has just hit the value-based care tipping point. According to the latest data from the Health Care Payment Learning & Action Network, more than half of all healthcare payments (60.5 percent) are tied to some level of quality or value measurement as of 2021. However, very few of those payments (19.6 percent) are linked to accountable care models that incorporate downside financial risk and population-based reimbursement.

Healthcare needs to keep the value-based care momentum going in order to achieve accountable care that delivers improved patient outcomes and cost efficiency. According to Megan Reyna, MSN, RN, system vice president for enterprise population health at Advocate Health, providers will need to harness data to unlock the opportunities still ahead for value-based care.

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The role of technology & data

Data is crucial in value-based care, but technology should be a tool to support clinicians, not a burden. Interoperability and making data readily available to clinicians at the point of care are essential for value-care success.

“Data is at the center of everything that we do,” explained Reyna in the latest episode of Healthcare Strategies. “Within value-based care, we need data to really help us drive where we're moving…It's looking at where we have opportunity, where we have buy-in from those who are participating, and where we can move forward.”

That reliance on data to influence value-based care strategy has allowed Advocate to succeed throughout the years.

“Our strategies to move value-based care might have looked different over the years,” Reyna said. “As the environment continues to change, as Medicare Shared Savings Program has continued to change, our tactics might have changed. We don't give up on the things that are working, but we need to keep thinking differently about what we can do, and technology is absolutely something that also has iterated with us and is something that we continue to look towards.”

But technology isn’t the whole solution; instead, it’s a piece of the value-based care puzzle. Technology has to work for the physician who is seeing the patient, Reyna stressed.

“Technology has to help that physician versus be something that's in addition to what they're doing,” she said. “So, we have to continue to iterate as the technology also gets better.”

With that in mind, innovation isn’t the technology but what the technology enables physicians to do. At Advocate, Reyna asks her team what the problem is and how the health system can solve it with the people and systems it has in place. Innovation springs from the data Advocate has on its patients, but that data isn’t always complete, accurate, or easily accessible.

The challenges of technology

Implementing technology in value-based care can be challenging due to existing infrastructure, technology vendor solutions, and quality reporting requirements, which is why technology should focus on solving specific problems and improving patient care.

But interoperability, or lack thereof, is still getting in the way of innovation in value-based care.

“The unicorn of all technology is not only interoperability and getting the data to us, but really having that data be interoperable and getting that data back to the clinician so they are able to use it seamlessly at the point of care. That's something that we're always trying to strive towards. It's something that we, as an organization, are always pushing our technology vendors to work with us on.”

Healthcare, as a whole, has made significant progress with interoperability. Nearly all non-federal acute care hospitals (96 percent) and 4 in 5 office-based physicians have adopted certified health IT, the Office of the National Coordinator for Health Information Technology (ONC) shared earlier this year. Almost two-thirds of clinicians also engaged in health information exchange with providers outside their organization in 2021, the federal office reported.

Still, poor data quality and ongoing issues with data exchange were top concerns for healthcare executives this year. Almost 70 percent of digital health executives also said there were gaps in their data.

Additionally, Reyna pointed out issues with technology vendors in general. For example, technology solutions promise to solve a specific problem for health systems, but the sometimes multi-million dollar investment also means ripping up the system’s existing infrastructure, which providers like Advocate have been building since their start with value-based care decades ago. Some vendors also apply fees to data collection, reporting, and exchange.

“We have a long way to continue to go with that,” Reyna said. “It's the unicorn still, but it's where our gold star is and what we look for within the technology that we implement.”

Data points the way

The future of healthcare should include widespread adoption of value-based care, with a focus on improving data interoperability and supporting clinicians in providing high-quality care, Reyna emphasized throughout the discussion with Healthcare Strategies.

“You just need to take one step forward,” Reyna said. “There’s always going to be an area of opportunity for us, collectively as a nation. We have a lot that we can work on within the value space. So, for a physician just getting into this, if you don't have all of the technology, if you don't have everything all put together nicely packaged and you haven't been doing this for several years, it really is taking one step forward.”

Providers don’t need sophisticated technology to examine their data as it is to uncover opportunities to improve patient outcomes and cost efficiency.

“In 1995, we definitely did not have the nice, cool technology. In 2012 [when Advocate joined the Medicare Shared Savings Program], we still didn't have what we have today,” Reyna emphasized. “You can really do this by looking at what your data says on an Excel document and saying: Are we making improvement?”

“As you move along the journey, you are going to want to implement other technologies and other things to really help you make real-time decisions,” she continued. “But don't let that be a barrier to taking the first step forward."