This monthly blog highlights and discuss emerging trends and challenges related to healthcare data and its ever changing life cycle.
By Maria R. de Leon, MBA, CCS
Since the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009, health information management (HIM) services in every healthcare organization are inundated with the speed of emerging trends in healthcare technology. The goal of the HITECH Act is for hospitals and office-based physicians to use electronic health records (EHRs) as a strategy to improve quality of care, safety, and efficiency. The EHR is the foundation for the value-based care that is now in place. Today, care delivery via EHR technology is integrated continuously in the daily practice of clinicians and other health providers.
Understanding the Value-Based Care Model
In the 2006 book Redefining Health Care: Creating Value-Based Competition on REsults, the authors discuss the principles of value-based care. They make the argument that competition in healthcare is not working. Costs continue to increase, but with limited services that often fall short and with mistakes in diagnoses as well as treatment errors that could have been prevented. As we look at the current fee for service (FFS) model, one of the drawbacks is that it is built on paying the volume of care rather than paying for the quality of treatment results. FFS is not linked to outcomes since physicians get paid whether patient health improves or not. Value-based care, on the other hand, is about paying for quality performance—that is, achieving desirable health outcomes. Redefining Health Care defines value in healthcare as “Healthcare outcomes per dollar spent,” where desired outcomes correspond to lower mortality and morbidity but with sustainable cost. To fully grasp the overall value of this care delivery model, it is best to mention the goals of value-based care which is aimed for the people to live longer, to live healthier, and to maintain a healthcare cost that is practical.
As the value-based care model is moving towards paying for performance, there must be standards for improved quality of care and quantifying the rate of reduction in healthcare costs. How do we measure performance, quality, consumer satisfaction, and cost? The key in obtaining this information is through EHR data collection.
Health Information Technology (HIT) as a Foundation in Healthcare Change
Accountable care organizations (ACOs) are one of the parties that use value-based contracts. This group of providers is mutually responsible for the quality of care and healthcare spending of their specific patient group. ACOs must reliably and accurately measure performance because providers are rewarded with incentive payments based on how they performed on the quality of care given to patients. The outcome of measurements must be openly shared with the providers with enhanced transparency. Measuring the goals of value-based care would require accurate data for statistical calculations, and HIT is essential in helping ACOs to meet compliance in measuring outcomes. Evidently, the majority of US providers are using software that captures the right measurements necessary to value-based programs as validated by the Office of the National Coordinator.
Managing the Health of Patients Through Data Integration
Since the rollout of EHRs, sharing of information among care providers through data connectivity has become the foundation of evidence-based practice to patient care. The importance of care coordination is crucial in value-based care. As mentioned earlier, payments in a value-based model will depend on the result of performance by providers that give services to the patient. If performance and cost are not aligned, the consequence is a loss of revenue. The role of data connectivity using EHRs has opened a window of opportunities both in prevention and prediction of illnesses. These opportunities are based on collected data that contain patient behavior, treatment, screening, chronic diseases, compliance with medication, and other pertinent information. Armed with crucial information of their patients, providers are now more efficient and predictive on risks, a strategy of care, and other options that would benefit the patient. Taking advantage of data collection and integration of information is not only projecting healthcare cost reduction; our government’s support and incentives to providers that meet the quality of care and reporting will motivate providers to develop a care approach that will be more efficient and tailored to individual patient needs. Moreover, the rapid development in technology allows a significant number of people to engage in the decision making process for their healthcare. This is in line with an acceleration of digital healthcare where the emergence of electronic tools is practically ubiquitous; hence, providers must be encouraged to adopt best practices in implementing current technologies for better data integration across the continuum of care.
Other Trends and Challenges
As healthcare IT advances, technology primarily plays a huge role in transforming healthcare delivery in the US. We can expect that this knowledge-intensive demand in data connectivity is a trend that is likely to continue for a long-term period using electronic health records and other HIT tools. Patients now have various options in obtaining the quality of care from different providers; thus, competition is expected among healthcare organizations as it will play a major part in selecting a model to deliver care. Another challenge is the complexity of issues in technology application. Since measuring and reporting of outcomes is the goal in determining quality, patient satisfaction, and cost, a culture of teamwork is required among physicians, care coordinators, and HIT experts to succeed in achieving a satisfactory result.
Porter, Michael E. and Elizabeth Olmsted Teisberg. Redefining Health Care: Creating Value-Based Competition on Results. Boston: Harvard Business Review Press, 2006.
Maria R. de Leon (Maria_dLeon@yahoo.com) is a consultant at Codemax Healthcare Consulting and a health information management coding professional at Kaiser Permanente.