Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid


Data Sharing Critical to Value-Based Purchasing, HHS Leaders Say

Data sharing, interoperability, and APIs are all top priorities for HHS and CMS leaders as they plan their next moves for the value-based purchasing transition.

HIMSS19, data sharing, and value-based purchasing

Source: Thinkstock

By Jacqueline LaPointe

- To move the industry to value-based purchasing, healthcare leaders are putting healthcare data sharing and interoperability high on their priority lists in 2019.

“Technology, and the sharing of data, underpin the entire move to innovative payment mechanisms in healthcare,” CMS Administrator Seema Verma emphasized at this year’s HIMSS conference in Orlando. “Without effective, open data sharing, providers cannot keep patients healthy. Without data to track patient progress or understand quality, insurance companies cannot tie payment to outcomes.”

In his HIMSS19 keynote, HHS Secretary Alex Azar also stressed the importance of data in the transition away from fee-for-service.

“Putting that data in the hands of patients and physicians is going to be essential to building a healthcare system that pays for value rather than procedures, one of the four priorities I have laid out as Secretary,” he said via video message.

The sentiments from the healthcare leaders illustrate the growing importance of executing robust data sharing and interoperability in the name of value-based purchasing and care delivery.

READ MORE: Best Practices for Value-Based Purchasing Implementation

The healthcare industry is well on its way to paying for value over volume. The Health Care Payment Learning & Action Network (LAN) reported that less than one-half of healthcare payments (41 percent) came from a fee-for-service model with no link to quality or value in 2017.

Stakeholders are moving forward with value-based purchasing, and some are seeing clinical and financial successes with the models.

However, significant obstacles remain, and chief among them are data sharing and access. A 2018 survey found that the value-based purchasing transition may be stalling because physicians do not have access to the tools they need for success, including EHRs, clinical decision support, data analytics, and EHR plug-ins or modules.

About 72 percent of respondents also said providers do not have all the information they need about patients for value-based purchasing success.

HHS and CMS recognize the importance of data sharing and interoperability for the value-based purchasing transition. Verma explained in her keynote speech that limited data sharing across the industry is stymying the transition to innovative payment models that reimburse providers for value, not volume.

READ MORE: Good Data, Better Value-Based Care Can Boost Population Health

Physicians are still faxing and printing data to give to patients and other providers, she explained. Some EHR vendors also own the provider’s data and providers must ask permission to use the information.

“This is a major barrier in our efforts to transform our payment systems to hold clinicians accountable for providing high quality, coordinated, and efficient care,” she stated. “The healthcare system needs greater technical efficiency so we don’t repeat expensive tests, run the risk of adverse drug interactions, and compromise patient safety – all things that drive up healthcare costs.”

Azar added that the lack of health IT advancement is also preventing HHS from achieving the four P’s of healthcare transformation.

“The first one of the four Ps is to empower patients to drive value as consumers,” he said. “Patients cannot act as consumers and they cannot drive value without easy access to information about their health.”

“A better health information ecosystem will also help us move forward on the three other Ps: providers working as accountable navigators of healthcare, paying for outcomes, and preventing disease before it occurs or progresses.”

READ MORE: Value-Based Contracts Rely on Patient Attribution, Data Sharing

In efforts to reduce costs and move the industry to value-based purchasing, CMS is planning to release data from “unusable silos,” Verma stated.

“Disruptive technology has already quietly entered healthcare, finding opportunities to transform not just the records systems, but the way we interact with and drive our own healthcare,” she said. “New companies are taking once trapped data and making it available for patients and innovators alike.”

“So, we can either stand in their way, or open the gates. CMS is opening the gates.”

The federal agency plans to take a more active role in seamless data exchange through policy creation. The agency expects to create policies that incentivize providers and patients to make healthcare decisions based on all of a patient’s data, including their payment information.

CMS recently took a step toward achieving their goal by releasing proposed rule. Just ahead of the 2019 HIMSS Convention, the agency proposed a rule that outlined the definition of information blocking, which has been heavily debated since the 21st Century Cures Act in 2016.

The proposed rule would also require hospitals to electronically notify providers in a patient’s care team when that individual is admitted, discharged, or transferred to another care setting.

But the proposed rule is just a first step for CMS, Verma stated.

“Our agenda is to create a future where the underlying databases that power our health system are connected using APIs and other modern technologies to not just share data, but incorporate it into a single record,” she said. “And in the future, hopefully the very near future, the data available won’t be limited to a predefined set of parameters. But will include the entire HIPAA designated record set.”

APIs, or application program interfaces, allow unrelated software programs to communicate with one another regardless of how each application is designed. Fast Healthcare Interoperability Resources (FHIR) is a major API in the healthcare industry, allowing EHRs to communicate.

CMS plans to leverage the power of APIs and specifically FHIR to make all of a patient’s data available to all stakeholders.

“With all of this data available, physicians and health systems will use tools like artificial intelligence and machine learning to help interpret the information to provide high quality, evidence-based, cost-effective care,” Verma continued. “And the tools that are used at the point of care will be user-friendly for clinicians. No extra effort or millions of clicks, meaning access to the right data, for the right person, when they need it.”

Greater data sharing and interoperability should cut costs and improve care quality, both goals of value-based purchasing, by enabling providers to track their patients throughout the care continuum, giving them the opportunity to more effectively influence care.

Robust data sharing will also ensure the information necessary for care delivery and payment is easily accessible to those who need it.

“This is data and knowledge that could change the life of a patient—or the trajectory of an unsustainable healthcare system. That’s the promise that lies within our data,” Verma concluded.


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