The Executive Suite: 5 VBC adoption habits centering on data

In the U.S. healthcare system, the transition from quantity-focused care provision of the fee-for-service model to a more nuanced model that rewards quality patient outcomes requires innovative approaches. As the journey to value-based care (VBC) delivery continues its long trajectory, providers and payers are leveraging healthcare data of all kinds for all purposes. Five VBC adoption habits put data front and center for stronger exchange, greater fluidity, easier accessibility, and more informed decision-making.

Powering healthcare decisions with data

Just a decade or two ago, most of the U.S. healthcare system was rooted in paper. Clinicians regularly shuffled through cabinets full of charts, piles of faxes, overstuffed in-bins, and back-pocket prescriptions. In many ways, we’ve celebrated a successful transition to EMRs, but in the larger sense, we haven’t fully recognized the power these collected data points hold.

There’s a great opportunity in the wealth of digital clinical and claims data: by leveraging information, better decisions result. Physicians require comprehensive clinical history at their fingertips to provide the best possible experience and care to their patients. From a payer perspective, insurance companies want their members to receive holistic care at the lowest possible cost. In leveraging use cases for this purpose, they must have the right data in the right format. From a contracting standpoint, they must also use the available data to clarify the costs of taking care of individual members. For all stakeholders of VBC, the most successful outcomes originate in data.

Removing data silos

As any clinical provider knows, a lot of the waste in healthcare is a result of siloed data. VBC simply demands better. For example, if a hospital’s system isn’t integrated with a specialist in another health network, the hospital provider may decide to order a laboratory or imaging test a second time. A lack of fluidity generates a significant amount of administrative work, leading to communication difficulties and medical errors/waste.

Despite the commitment of many providers to modernize systems for better interoperability overall, hurdles caused by legacy systems persist. Governance challenges—including a lack of support, lack of trust in the data, training difficulties and resource limitations—also hinder progress. Numerous initiatives, platforms, and strategies ensure data flows more smoothly between systems. By seeking them out, providers put themselves in a better position to access and leverage the data needed to make critical healthcare decisions.

Making data accessible

From a data accessibility standpoint, health systems, health plans, and patients must be able to gather relevant information regarding the management of care. While the former two have typically had considerable access, the 21st Century Cures Act—which requires that healthcare providers give patients access to all of the health information in their EMRs without delay—has furthered patient access to their digital medical records data.

Additional stakeholders requiring access to health data include the CMS, ONC, and innovators in the health technology space creating solutions and platforms that seek to overcome interoperability obstacles. Due to privacy standards and concerns, vendors continue to face challenges regarding medical data access as they attempt to remedy system problems.

Augmenting clinical data with SDOH

Social determinants of health (SDOH) are the non-medical factors that influence health outcomes.1 Last year, CMS issued guidance to state health officials designed to drive the adoption of strategies that address SDOH2 as part of its efforts to advance VBC. This is an important step forward, the data providing clinicians with a much clearer picture of the whole patient.

When driving a care management plan, providers can consider how SDOH may impact the patient’s ability to adhere to the program and tailor the plan—or the means to which they can achieve it—accordingly. This benefits all stakeholders as patients whose socioeconomic factors are appropriately addressed experience improved health outcomes, typically at a lower cost to the overall system.

Operationalizing data for risk stratification

Just as data enables patient connection to resources that will support wellness, it can also inform providers about who is most at risk for nonadherence to treatment plans. Using this information, providers choose which patients may likely benefit from specific interventions and apply them optimally.

From the payer point of view, the VBC model encourages interest in specific risk levels associated with a member versus focusing on how many visits they may have had. Detailed analysis of chronic conditions, for example, will further inform the development of a holistic care management plan. Innovators in the field are taking a consultative approach to help providers and payers operationalize data to treat at-risk populations.

As VBC encourages more efficient healthcare processes through best practices, the industry will continue to experience how data informs decision-making. Innovators who help data flow freely between health systems, health plans, and patients will remain integral to VBC’s success.