Why value-based care needs real world data & analytics

As providers begin to switch from Fee for Service (FFS) models to Value-Based Care (VBC) models, we are seeing an increased investment in data and analytics systems. In a recent value-based care 2019 survey, Definitive Healthcare found that the biggest barriers to moving to a value-based system include (1) lack of resources (like insufficient Healthcare IT software systems) and (2) gaps in interoperability. In both instances, data is king. There is no question: VBC models require more sophisticated data, analytics, and payment structures.
Recently, Definitive Healthcare hosted its second virtual value-based care panel, with three healthcare leaders who were able to dive into how they measure value-based care success in their organizations. The panel included:

• Dr. Gary Wainer, D.O., Chief Medical Officer at Innovista Health Solutions
• Susie Valentine MBA, VP of Population Health, Healthcare Provider Connections, Inc.
• Dr. Randall Taubman, M.D., President of Inovo Health Corp & Affiliate Assistant Professor of Medicine, Charles E. Schmidt College of Medicine at Florida Atlantic University

In this webinar, the panelists touched on a wide variety of value-based care topics, but one underlying theme resonated throughout: the deep importance of real world data.

What is Real World Data?

Technologies like computers, cell phones, wearables, and electronic health records (EHRs) gather and store health-related data, and this data collection has only accelerated as these systems become more mainstream. The ability to review and analyze this data is paramount when it comes to maximizing claims revenue in a value-based world.

With this emphasis on the collection of healthcare data, providers are now looking to invest in data analytics infrastructure or vendor-sponsored systems to help analyze quality metrics, monitor progress, and make any necessary improvements.

Real World Data - According to the FDA (U.S. Food & Drug Administration), real world data refers to the data relating to patient health status and/or the delivery of healthcare routinely collected from a wide variety of sources, including:

• Electronic health records (EHRs)
• Claims and billing activities
• Product and disease registries
• Patient-generated data including in home-use settings
• Data gathered from other sources that can inform on health status, such as mobile devices
   

How does RWD tie into Value-Based Care programs?

Value-Based Care programs are all-encompassing, and therefore data must waterfall down through three main buckets comprised of providers, patients, and payors:

1. Payors are a key piece of the puzzle, because they sit on large sets of patient data. If you think about it, when a patient goes to a specialist, the emergency room, or even their primary care provider, they bring their insurance card wherever they go. With value-based care programs, payors will be responsible for getting this raw claims data into the hands of providers in a tangible way, so that they can get a clear picture of the entire patient journey.

2. Providers generally feel that their EMR/EHR systems simply aren’t sufficient when it comes to pushing relevant data to the right care team members and their devices, as shown in a 2019 study on physician cognitive overload conducted by Definitive Healthcare and Vocera Communications. In order to be successful in the value-based care world, providers will need for these systems to have greater interoperability: the ability to exchange information between disparate vendors with different interfaces and components. Without this functionality, providers aren’t seeing the full picture. They need to know which of their patients need a breast cancer screening, immunization, colonoscopy, etc., and need EHR systems that have the ability to filter through patient data and prioritize care with alerts.

3. Patients want to feel like an individual, and not just a number. Consumerism and personalized care are driving forward the VBC model, based on quality scores, care management surveys, and patient satisfaction results. Patients are responsible for letting their care providers know if they succeeded, by meeting their needs and providing proper treatment.

In an ideal value-based care world, all three of these segments will work together in perfect harmony. And that is exactly why it’s so important to have data analytics platforms, in order to ensure all three segments are collaborating effectively. But, even with these three segments working in tandem, there is a whole other dimension to take into account: all-payor claims.
 

CMS and commercial claims data

When it comes to healthcare claims data, there are two large components: the private, commercial insurance side (primarily comprised of those under 65 years old) and the public, Centers for Medicare and Medicaid Services (CMS) side, which is primarily comprised of those above 65 years old. 

Historically, all-payor data has been difficult and time-consuming to access and analyze. On one hand, there are the public Medicare and Medicaid claims, where it is important to market to elderly populations. You want to ensure that these patients are making their routine physicals and that treatments are being documented accurately in the EHR system. On the private side, you want to follow specific metrics for population health; for instance, are children are getting their immunizations? Are patients getting their preventative breast and cervical cancer screenings?

In order to get a realistic view of the entire market, it is important to have the ability to review the entire scope of claims data to help physicians understand how they are performing and benchmark their progress against that of competitors.
 

Putting it all together

The data we need for these VBC programs exists, but it can be a slow-moving process. Even with an intervention, providers may only start to see results three to six months down the road, and it could take over a year to collect the entire scope of data to evaluate physician performance appropriately. Elements like cost data, which can be most challenging, often take over 1.5 years to reconcile and determine outcomes. That is why it is so important to look at VBC programs with an eye to the future, understanding that these programs are a journey and not an endpoint.

As we move forward, healthcare IT systems are going to become key drivers, helping improve provider workflows and interoperability to maximize the potential for success. Population health management, health information exchange (HIE), and business intelligence tools will become critical to effectively managing value-based care delivery.

According to Definitive Healthcare data, only 36 percent of hospitals currently have the IT infrastructure in place to manage all three components of successful value-based care. Without such tools, hospitals can struggle to manage their data properly, identify gaps in care, target quality improvement projects, and identify high-risk patients. Developing the infrastructure to manage all three components can lead to overall better patient care and more success in the value-based care market.

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