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

Value-Based Care News

Ensuring Success in the Transition to Value-Based Care

The federal push for value-based care reimbursement is set to create numerous challenges for healthcare organizations and providers.

By Kyle Murphy, PhD

- Most recently, the Department of Health & Human Services issued a final rule for the Quality Payment Program as part of implementing provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The program comprising the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) builds on the federal agency's goal to convert half of current fee-for-service Medicare payments to value-based payment models by 2018.

Value-based care summit

To achieve this goal, healthcare organizations and providers will require insight into the quality of their care, their efforts to improvement care delivery, their ability to use and share electronic data, and their management of care cost. Gaining an appropriate level of insight will require industry stakeholders to work together to develop strategies for coordinating and making efficient use of strategic partnerships and data-driven technologies.

Next month, leaders from the healthcare industry will convene at Xtelligent Media's Value-Based Care Summit, a one-day event that will explore numerous aspects of value-based care models and allow participants to hear as well as share their own best practices for succeeding in a pay-for-performance world.

In the run-up to the event on November 15, our editors have sat down with several speakers and panelists who have offered a sampling of what to expect come next month.

Importance of healthcare analytics for value-based care

READ MORE: Bundled Payment Models Here to Stay Despite CMS Program Delays

“The world has moved much further forward with electronic medical records and developed more sophisticated abilities to not only capture, but analyze data,” Atrius President & CEO Steven Strongwater, MD, recently told “There is also better alignment between using that data and a focus on better outcomes where patient experience is a part of the equation.”

Strongwater will be delivering the keynote address at next month's event, a talk that will provide details about how his organization has made and continue to make inroads in value-based care implementation. Atrius Health has an impressive track record in accountable care with its Pioneer ACO already managing to generate millions in shared savings.

Listen to the latest podcast featuring Steven Strongwater, MD:

According to Strongwater, Atrius Health has come to rely heavily on health data analytics to identify patient populations with high levels of risk and intervene before patients end up in the emergency room.

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“You can also intervene with them through biometrics or telephone intervention, or if that’s not sufficient, you can deploy a nurse practitioner to their home and treat them at home," he explained. "You avoid the emergency visit, disruption in their work life if they are working, and you can prevent some of the complications of heart failure that can lead to higher costs.”

Ensuring a successful transition from fee-for-service to value-based reimbursement requires in the right kind of technology, Strongwater asserted. And the time is ripe for implementing it.

“In the near-term, the hope would be that infrastructure could be built that is forward capable and scalable,” Strongwater said. “That includes the ability to capture and analyze data as well as the ability to provide feedback to the clinicians, so they can begin to manage those populations."

This and more Strongwater will address as he kicks off the Value-Based Care Summit.

Delivering usable real-time health data to providers

READ MORE: MIPS Reporting Success Depends on Choosing Suitable Measures

A period of processing must occur before health data aggregation becomes actionable, usable data in a clinician's hands. A value-based care environment requires that health organizations narrow that gap so that providers can make medical decisions based on the most accurate and timely data.

“Understanding the dimensions of time is a very significant challenge for analytics, and the issues vary with the timescale that you’re looking for,” Saint Francis Care's Chief Data and Analytics Danyal Ibrahim, MD, MPH, told in a recent interview.

"You may have a patient surveillance system that requires really large datasets to monitor their vitals and maybe do some predictive analytics about how they’re trending, and that requires immediate, truly real-time insights for the patient while they are still in your care setting."

Ibrahim's observation touches upon an important component about health data. Data aggregation for its own sake is meaningless. Collected data must serve a purpose in guiding future clinical decision-making.

What's more, clinical end-users want to be able to see data at multiple levels, from a single individual to an entire population.

“If I’m a care quality program leader, I want to see a whole data set about the entire population,” Ibrahim said.  “I want to identify problems and figure out where that low-hanging fruit is so I can make large-scale changes over time.  I might be looking at diabetic weight loss over months or even years, or watching ED usage rates over several performance quarters before I can see any meaningful trends.  It’s a different approach to analytics.”

As part of the panel, "Big Data, Big Problems, Big Rewards: Putting Population Health into Action," Ibrahim and other speakers will discuss the health data needs of providers treating populations of patients across multiple settings of care.

Making EHR technology work for value-based care

Health data analytics are unable to inform effective clinical decision-making unless powered by accurate and reliable electronic data. Fortunately, the EHR Incentive Programs have increased the adoption of certified EHR technology over the past five years.

Micky Tripathi, founding President and CEO of the Massachusetts eHealth Collaborative (MAeHC), sees that as a positive sign that healthcare organizations and providers have the basic digital tools to succeed in value-based care programs.

“All of the certified EHR technology tools available are going to have at least a base capability to perform decision support analytics and registry activities, so the functionality will be there," he said.

However, these systems require EHR optimization to ensure that they can support end-users in meeting the goals of value-based care that require health data to be actionable.

“Having the ability to collect and use electronic data is foundational – and you can’t just use it as a documentation system,” Tripathi continued.  “You have to enable as much of the built-in clinical decision support, registry functions, and analytics as possible.”  

As part of a roundtable discussion at the Value-Based Care Summit, "Architecting the Value-Based Care Environment," Tripathi will speak to the health data aggregation and analytics needs of providers as the policies and governance necessary for ensuring that actionable data is available to clinicians at the point of care and can improve patient outcomes.

Redefining the point of care

In a value-based care environment, the patient plays a central role. And part of making care patient-centered involves taking into account the needs of patients, such as where the point of care is.

Telehealth and mobile health (mHealth) have expanded the definition of the point of care tremendously, adding convenient ways for patients to access medical services. At the same time, they are at loggerheads with reimbursement policies belonging to a time when such capabilities did not exist.

As a result, healthcare organizations and providers looking to establish a mHealth and telehealth presence must straddle an unclear line.

“We need to recognize that we still have a foot in two canoes.” Dartmouth-Hitchcock Medical Center’s Center for Telehealth Founder & Medical Director Sarah N. Pletcher, MD, told “That means having some difficult conversations with stakeholders.”

Expanding this presence also brings to the fore questions about value relative to remote care delivery, which Thomas Scornavacca, Jr., DO, Senior Medical Director of UMass Memorial’s population health initiative, has worked to answer.

“We’re right at the brink of being ahead of the curve,” he says of the new risk-based landscape. “You have to be transparent in how you view quality in this environment, and give the primary care providers a voice in how they want to move forward.”

For Scornavacca, much of the challenge lies in convincing providers of the value of using mHealth and telehealth services to treat patients.

That experience mirrors that of Danielle Louder, who directs the Maine branch of the eight-state NorthEast Telehealth Resource Center.  Although for Louder, the challenge isn't so much convincing providers as it is sharing use cases that have worked with the provider community in an effective way.

“People still take a very traditional view in how healthcare systems are reimbursed. There’s no mandate for private payers to be consistent,” she said.

All three will be addressing attendees at the next month's event. In the session, "Telehealth in the Northeast: Overcoming Challenges, Enhancing Access and Impact," Louder will explore how policy and payment impact the use of telehealth services throughout the northeast. Meanwhile, Scornavacca and Pletcher will discuss the challenges associated with bringing providers, patients, and payers together for telehealth in the panel, "Using Telehealth to Connect Providers, Patients, and Payers."

To learn more about how healthcare providers can leverage big data analytics strategies for a successful transition to the value-based care environment, sign up for a seat at the Value-Based Care Summit on November 15, 2016

Visit today to register.


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