The shift to value-based care has turned “business as usual” on its head for many health and human service provider organizations. It’s forced the executive teams at those organizations to operate while simultaneously using a growing percentage of value-based payments in a fee-for-service environment, and do so while shifting their strategy to population health (see Where Are Behavioral Health & Social Service Organizations With Value-Based Reimbursement? The Numbers Are In). And the key to making the most from diminishing margins is tracking quality measures — and to do that before payers ask.
There are seven key infrastructure competencies every provider organization should have to track quality in services and operations:
1. Capacity to Collect Data: What population does your organization serve, and what are their health needs? The fundamental competencies needed to answer “yes” are a fully implemented electronic health record (EHR); structured data collection around assessments, diagnoses, and services; workflows and processes to ensure data integrity; and the ability to collect data at the time and source of service provision (see From Data Modeling To Data-Driven Decisions).
2. Capacity to Analyze Data for Population Health Management: Do you have the ability to perform strategic analysis of data for risk stratification and care management? The fundamental competencies needed to answer “yes” are the ability to develop or access consumer data registries; develop analysis tools; implement risk stratification strategies; and integrate multiple sources of data (see Can Data Fix It?).
3. Ability to Manage Value-Based Contracts: Do you have the ability to track performance metrics, submit invoices, and maximize performance of value-based contracts? The fundamental characteristics needed to answer “yes” are: EHR functionality that meets billing requirements for value-based purchasing models; the integration of clinical, operational, and financial data; unit-costing and cost-accounting capabilities; and predictive modeling and forecasting capabilities (see What Do You Need To Demonstrate & Manage Your Value?).
4. Ability to Exchange Health Care Information: Do you have the ability to exchange clinical and financial information with other health care provider organizations? The fundamental competencies needed to answer “yes” include: health information exchange agreements with key providers; secure infrastructure; policies and workflows that comply with Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH); service notification agreements; automation; and processes with other providers (see Making Behavioral Health System Information Exchange Work).
5. Technology Supporting Care Coordination Functionality: Do you have the ability to manage eligibility, coordination of benefits, inquiries/referrals, decision support, care authorization, care coordination, and utilization management. The fundamental competencies needed to answer “yes” are automated risk-assessment tools; redesigned workflows to maximize care management technology; and provider referral database to aid in care matching and management (see The Future Of Care Coordination? It’s Elementary, Watson).
6. Consumer Portal Functionality: Do you have the ability to provide service data, resources, and interaction options with consumers through the EHR? The fundamental competencies needed to answer “yes” are: convenient, secure access to personal health information through the Internet; the ability to access staff and services through technology; and access to forms and account payment functionality (see Less Consumer Education Demands More Consumer Engagement).
7. Real-Time Performance Measurement & Reporting: Do you have the ability to monitor actual IT outcomes against established goals? The fundamental competencies needed to answer “yes” are measurement of established key performance indicators, as well as the generation of real-time reporting on performance under value-based reimbursement arrangements (see Metrics Are A Leadership Issue).
For more on the reporting competencies for population health management, check out my presentation with John M. Sheehan, President & CEO, Harbor Behavioral Health, Technology & Reporting Requirements For Population Health Management: Preparing For Value-Based Reimbursement, from last month at The 2017 OPEN MINDS Performance Management Institute.
And for more live, join the OPEN MINDS team on June 6 in New Orleans for The 2017 OPEN MINDS Strategy & Innovation Institute and the opening keynote address, “Humana’s Digital Transformation: Redefining The Consumer Health Care Experience,” featuring Jeff Reid, Executive Vice President, Digital Center Of Excellence, Humana.