A very common area for confusion is the “technology functionality” needed by provider organizations in the years ahead. I thought of this when I read a summary of the report by KLAS Research, Third-Party Vendors Get Leg Up On EMRs For Meeting Physician-Led ACO Needs. The conclusion – EHRs are not meeting the needs of provider organizations that are managing ACOs. This should not be a surprise, but it was to some of my colleagues.
So, let’s start at the beginning. What is the basic functionality that provider organizations get from their investment in an EHR? This is a complex question, because even basic EHRs have a lot of options and features. My colleague, Joe Naughton-Travers, in his article Software Selection for Behavioral Health & Social Service Organizations: A New Focus on the Customer/Vendor Business Partnership (Part I), provided this high-level list of functionality:
- Consumer and staff demographic and billing data
- Scheduling and eligibility verification support
- Service delivery data
- Service billing capabilities
- Accounts receivable management
- Electronic medical/case record functionality
- Clinical decision support and outcomes management
- Staff alerts, messaging, and tickler systems
- System security functionality
- Report writing functionality
- Point-of-service system access
As I read this list, I see a perfect fit for practice management. What I don’t see is the functionality needed by provider organizations to move beyond the provision of client services, to models that involve population health management through gain-sharing, case rates, or capitation.
For population health management – whether via a medical home or an accountable care organization (ACO) or an episodic payment model – service provider organizations need additional organizational competencies related technology functionality. These additional organizational competencies are shown in the chart below.
And, these new organizational competencies need technology infrastructure to support them. The functionality required depends on the type of risk-based contracts an organization intends to develop – whether case rates or capitated types of models. The differences in this functionality are shown below.
While I think many management teams are unhappy to learn that their significant EHR investment is not enough to take them through the evolving world of value-based payment without enhancements, now is the time to consider those functional needs, if moving to gain-sharing, P4P, or risk-based contracting is in your future. For more information on this topic, check out:
- A Checklist for Managed Care Readiness for FFS Contracting
- Managed Care Systems: First Steps in Selection
- Managed Care Systems: A Comprehensive Selection Guide
And, for a deeper dive, check out this session – Financing In Flux: Succeeding In The Era Of Value-Based Contracting – led by my colleague Howard Shiffman at the 2014 OPEN MINDS Planning & Innovation Institute.