Getting from “here” to “there” is the challenge for many organizations moving from traditional fee-for-service (FFS) to value-based reimbursement. That was the focus of my web briefing with Scott Green, Senior Vice President of CareGuidance at Netsmart, last Thursday, Policy Update & Foundations Of Value-Based Care.
Regardless of what happens with health care policy (from retaining the Patient Protection & Affordable Care Act to adopting the more state-centric legislation proposed by the House of Representatives), every upcoming policy scenario involves more value-based reimbursement of provider organizations. And that transition brings a new and more competitive business model to the health and human service field.
I see three challenges to making this transition – the analytics infrastructure to provide real-time performance data; the management team to use that real-time performance data; and the capital to create the analytics infrastructure.
During our briefing, Mr. Green provided a more granular view of my “big picture” thinking about the changing business model. He took a more functional look at the technology infrastructure needs to support value-based care. His five pillars were: analytics, care coordination, evidence-based practices, consumer engagement, and interoperability.
Each functional area brings its own technology infrastructure requirements. For analytics, you need a solution that will allow stratification; registries; cohorts; data analytics; performance measures; and reporting (see Data-Driven Decision-Making: Moving To An Organizational Measurement Culture and Performance Data, Dashboards & Metrics-Based Management: Meaningful Data For Meaningful Decisions).
For interoperability, the basic question is who are the organizations and stakeholders in your network that you need to connect with, and what technology will it take to connect with them? The answer is health information exchange (HIE) connectivity; Direct messaging; telehealth; provider referrals; and the ability to query networks (see Will Security & Interoperability Shape Our Health Care Future? and What Is ‘Blockchain’ & What Will It Mean For Your Tech Strategy?).
Care coordination functionality requires adopting and understanding the technology that supports data aggregation; case management; referrals; assessments; performance measures; and reporting (see The Future Of Care Coordination? It’s Elementary, Watson and Is Your Organization Ready To Be ‘The’ Care Coordinator?).
Consumer engagement, which is difficult to operationalize, requires provider organizations to have the ability to monitor consumer health and then provide resources that allow consumers to interact in turn: this includes text messaging; consumer engagement; provider email; appointment reminders; and consumer education (see Making Consumer Engagement A Reality and In Health Care Tech Investments, Keep Consumers Part Of The Equation).
Last but not least, Mr. Green included evidence-based practices (EBP) on this list of functionality requirements. He listed multisystemic therapy (MST), Reaching Recovery; first episode schizophrenia; and motivational interviewing as examples of this functionality. And in our discussion noted that it is not only the EBP, but the decision support tools to know which consumers are best served with what interventions (see Taking Decision Support From Concept To Practice and Clinical Decision Support: More Than Just ‘Alerts’ Tipsheet).
Where does all this lead? Value-based reimbursement (VBR) – for more on VBR, check out these resources from the OPEN MINDS Industry Library.
- The Business Model Transition To Value-Based Care
- The Financing Challenge For Providers With Increasing Managed Care & Value-Based Contracting
- Community-Based Providers In A Value-Based World
- The 2017 OPEN MINDS Performance Management Executive Survey: Where Are We On The Road To Value?
- Remaining Profitable In The Transition To Value-Based Payment
And for more on using your data to your best advantage, join the OPEN MINDS team on November 7 for the session, “Moving From Big Data To Smart Data: How To Integrate Clinical & Financial Data To Manage Performance” at The 2017 OPEN MINDS Technology & Informatics Institute in Philadelphia, Pennsylvania.