As specialty provider organization executives look to the future, one strategic issue that is a constant is the need for technology investments. In my conversations with those executives, the question is: what investments? And, where does their current investment in electronic health records (EHR) fit in?
That was the focus of the session Taking Your EHR From Data To Strategic Information: Real-World Cases Of EHRs Supporting Value-Based Care, at the The 2019 OPEN MINDS Management Best Practices Institute. I moderated a townhall session featuring Brandon Ward, Psy.D., Director of Enterprise Applications, Mental Health Center of Denver; Scott Green, Senior Vice President and General Manager, Human Services, Netsmart; and AJ Peterson, Vice President of Interoperability, Netsmart; and where the focus was on moving EHR functionality to the next level.
The recommendations of the panel? There are six “next step” areas of functionality that executive teams should evaluate— optimizing reimbursement; interoperability and data exchange strategies; virtual care; integrating care; quality measures and social determinants of health (SDH); and leveraging analytics.
Optimizing reimbursement—With the over four thousand health plans, and over 900 ACOs, there are far too many different requirements spread across countless contracting models for any “team” of people to keep up with all the different reimbursement requirements. “Optimizing reimbursement” will rely in large part of automating more processes because it’s not humanly possible to cope with all the changes manually. That is another “next generation” EHR capability. Dr. Ward explained:
The process of automation has really taken off. Previously, our billing staff for claim submission would have to produce hundreds of files for the various payers. That’s one full-time employee (FTE) doing eight hours a week just to produce that. With the automation, we went down to less than one-hour a week. Similarly, when those files came back, there were two FTE working full time to post that information. That’s now one person working only four hours a week on it, and they just do the verification to make sure it ran correctly and that there aren’t things to correct.
At the end of the day, the time savings are spectacular. The billing staff is excited about that, as you can imagine. One direct result is that the number of errors has gone down, because in a manual setup, sometimes files were missed. Also, in that environment of manual processes, there were a lot of instances where we needed to delay processing smaller payers because the priority was on the bigger payers. That led to ups and downs and gaps in revenue data over time. Because of this, we didn’t have the ability to do a lot of forecasting, but now billing data goes out and in daily, and we can forecast more reliably. Now the billing staff can focus on what they perhaps wanted to do with their careers, like being billers. That includes being able to work denials more comprehensively which results in a greater ability to realize revenue for services provided.
Interoperability and data exchange strategies— On-demand data exchange and interoperability are essentials to care coordination and managing transitions of care. The ability to receive and share information about consumers with other health and human service organizations is essential for managing performance in a landscape focused on performance and value. Dr. Ward explained:
Waiting three weeks for records is almost useless because that’s basically just a historical records dump. Having real-time, on demand access to clinical data across networks of providers, integrated discretely into the clinical workflow, drives provider efficiencies and decision support at the moment providers can actually benefit from it, not weeks later. In terms of the process of implementation, there are some challenges despite data exchange not being a new concept. There are different rules by state for behavioral health and there is 42 CFR Part 2 at a federal level. While we could exchange data all day long, we needed a way to handle consumer privacy in a way that also legally protected us. In addition, adjusting to a new process with providers isn’t always easy. We try to work with them to understand where these changes best fit in the workflow. Having a robust consent management module integrated within the EHR, will give providers and consumers that ability to share behavior health and substance use data with primary care and hospitals while adhering to consent requirements.
Virtual care—With the focus on value and on consumer experience, improving consumer access is key. Virtual care (telehealth and service on other tech platforms) is an essential ingredient in meeting the new expectations around access, and 85% of health plans now reimburse for services delivered by telehealth (see What Are Health Plans Actually Doing?). EHR systems need to be structured to serve as the datasharing platform for those services. Mr. Peterson explained:
How do we connect people to consumers faster? Telehealth is picking up momentum. When we think about telehealth, it’s how to get the right care, place, time. It’s seeing provider organizations partnering with hospitals or emergency rooms or schools to enable their network to be available for consumers in crisis. And dedicating care teams to these initiatives in an integrated way that ensures available provider capacity at your organization is maximized. The days of the “telehealth room” are waning. Organizations will need a telehealth integration strategy that enables virtual practices to exist seamlessly from within the EHR.
Integrating care— Much like politics, all integration is local and there are many approaches to combining behavioral health and primary care (see Integration Strategies For The Complex Consumer Market and Will Health Plan Backward Integration ‘Remake’ Specialty Care?). No matter the approach, clinical delivery systems need systems that can support care integration, as in integrated processes and collaborative care through the ability to integrate clinical data into the service delivery workflows. Mr. Peterson asked, “Can you identify and send data electronically? This is about taking down the boundaries to data sharing between health and human service providers and doing it in a manner that the data exchanged becomes insights that improve the clinical process.”
Quality measures and social determinants of health (SDH)—As the shift to competing on performance and value becomes more sophisticated, the measures required to compete will shift as well. The ability for EHRs to support quality and outcome measurement tools and to record information about consumer social services needs are the “next generation” in increasing value.
Leveraging analytics— Using data in strategic decisionmaking is one of the key competitive advantage differentiators in health and human services, which is no surprise (see Structuring (& Budgeting For) Analytics and Innovation In Medicaid? The Key Is Analytics). A key for success in a performance-based world is the ability to use EHR data and data from other organizations to navigate both organizational management and management of value-based contracts. Mr. Green noted:
In the future your ability to use data to create and monitor cohorts will be critical to applying scarce resources in the best manner possible. Start with the data you have and begin to apply a formula that moves you from a static risk assessment to a profile that will give you a risk stratification in real time.
This discussion of “next generation” tech functionality is important not only for technology planning, but for developing strategies for continued competitive advantage and sustainability. With the continuing move to VBR, having access to real-time data about the consumers being served is key to building an effective and efficient service delivery system.
For more on interoperability and health information exchange, check out these resources from the OPEN MINDS Industry Library:
- Health Information Exchange—Can Work, Isn’t Working
- How Can We Improve Behavioral Health Data Exchange? The Challenges & The Opportunities Of HIE
- Without HIE, Participation In ACOs Is Limited
- HIE – In The Works In Los Angeles
- Stop Integrating Data & Start Liberating Data
- HIE Not Only Improves Efficiency – It Saves Lives
- HIE 3.0?
- How To Be Operable In An Interoperable World
- Data Exchange Via Mail & Fax? In Today’s Market?
- Are You Strategically Interoperable?
And be sure to mark your calendar for October 28-30, when we will host The 2019 OPEN MINDS Technology & Informatics Institute at the Loews Philadelphia Hotel. This year’s institute will focus on tech tools executive teams needs to move their organization into a value-based savvy market position.