By Diane M. Carr, Advisor
Tackling barriers to data usability and interoperability is one priority for action in 2018 that almost everyone in healthcare can agree on. Providers, payers, consumers, IT professionals and vendors too often find ourselves in the paradoxical position of being data rich and information poor. While mobile devices, ubiquitous internet access and seemingly limitless Cloud computing now make patients’ information accessible 24 x 7, in many instances, we continue to struggle to translate data into useful information and information into action.
The challenges are particularly obvious as we strive to support care management for high need populations. At the 2017 ONC Annual Meeting in November in Washington, D.C., it was apparent that Value-Based Care, i.e., reimbursement models that pay for quality, instead of volume, is here to stay. While the federal government may intend to relax or delay certain government mandates, such as bundled payments, many organizations have discovered that they support their mission of providing care regardless of the ability to pay. VBC is population-based, not just individual patient-focused care.
A cultural and financial shift is underway across the healthcare industry: a change which prioritizes a holistic view of patients and families within their communities, with emphasis on care coordination enabled by data sharing and integration. The CMS Innovation Center’s State Innovation Model (SIM) awards support development or implementation of plans at the state level. Public and commercial payers, providers and patients collaborate in a statewide strategy to transform health care payment and delivery systems through multi-payer reform and other initiatives. Each state-led model seeks to achieve the Triple Aim: improved quality, lower costs, and better population health.
At a breakout session, representatives from SIMs in Michigan, Oregon, Connecticut and Oklahoma discussed their efforts to improve interoperability to reduce service delivery burdens. The approach in Oklahoma is especially intriguing. Their HIE, MyHealth Access Network, serves as the “bridge organization” that links state referral services to healthcare providers and community services, such as housing, transportation, social workers, food and nutrition programs. Patients seeking medical care are screened for five basic human needs that can lead to poor health outcomes. In effect, the Oklahoma SIM is developing a standard data set of “social determinates vital signs” to integrate social and medical needs in their communities.
The success of these and similar efforts requires a network of clinicians connected to community services by a data services infrastructure: a unified patient record across the network, a quality plan which includes standards and metrics, key quality and operational indicators, secure information exchange. The technology exists to design and share public data sets comprised of health and non-health (non-medical) data to assist in care coordination capabilities. We need to make better progress in collaborating, not competing, to get the right data to the right people at the right time.
The volume to value shift is a paradigm that technology has the ability to transform. We need to understand whether new business models are altering utilization patterns or vice versa. StarBridge Advisors offers leadership, talent and commitment to meet this challenge.