Todd Charest

Quantity vs. Quality: Using Technology to Shift to a Value-based Care System

Written by Todd Charest, Chief Innovations and Product Officer for Ingenious Med

The healthcare industry has been steadfast in pursuing three specific goals: improving the patient experience, decreasing the cost of care and improving population health.

As technology advances and policies change, healthcare providers are increasingly looking for ways to achieve these goals. Healthcare has traditionally been driven by a fee-for-service, volume-based model which rewarded health systems and providers for seeing and serving patients. With the Affordable Care Act and CMS shift to value-based care, quality not just quantity has taken center stage.

To highlight this need for change consider these two facts:

• The U.S. has had a significant disparity between cost and quality of care unlike many other developed countries. We spend roughly $8,500 dollars per capita on healthcare and have a life expectancy of 79, whereas many other countries spend $4,500 and have longer life expectancies.

• The aging population is another impetus for shifting to a value-based care system. Each day, 10,000 people enroll in Medicare, and with this “silver tsunami” comes more aging Americans with chronic illness. Meanwhile, an unprecedented number of physicians are reaching retirement age.

To support the shift to more value-based reimbursement and care, health systems, providers and risk-baring entities should consider and implement three broad strategies including:

• Adopt a data-driven culture and use emerging data sets
• Focus on multidisciplinary care team support networks
• Make greater use of technology for convenience and care plan compliance

To see a successful shift to value-based care, all three strategies must be acted upon.

Data-driven Culture

To gauge the effectiveness of healthcare improvements, organizations require data and the ability to gain insight from it. This requires a culture of asking data-related questions first and then moving to intuition and experience. The most widely used and readily available data sets are claims-based financial data. The next set is clinical data across care settings, which is becoming more accessible due to the conversion from paper-based systems to digital records and new interoperability trends such as the FHIR standard.

Without a way to analyze the data and use it to make more informed decisions, it serves no purpose. Healthcare providers must identify partners who can leverage this information to make the data actionable at the point of care. Using data to make smarter decisions will cut down on per capita cost while improving the care patients receive.

We must not stop, however, at financial and clinical data sets. New frontiers of data include psychographic, sociodemographic, continuous biometric data from wearables, and genetic data which will further refine our medical communities understanding of care plans and predictive responses to treatment and lifestyle.

Care Team Support Networks

In regard to the sociodemographic data set mentioned a moment ago, if a patient is prescribed a treatment plan but doesn’t have a car to get to appointments or doesn’t have someone to care for them, they may have trouble complying with the care plan prescribed. Therefore, the patient may need new support systems to recover or remain healthy. Financial and clinical data sets typically do not cover these areas but are arguably even more important to a patient’s journey toward improved health. This highlights the need for any risk-baring entity to address key care teams across the spectrum of care settings. Ensuring that physicians, nurses, care managers, pharmacists and many others across the various healthcare disciplines are all aligned and work with the patient to support them in recovery or wellness is critical, but we must not stop there.

We are in a shift toward new partnerships between healthcare organizations that traditionally have worked independently. These will begin forming community-based organizations that work together for better community health. Ultimately, no single healthcare organization can make a community healthy on its own.

To truly improve population health – the health outcomes of groups of individuals – organizations need to broaden their definition of community and collaboration. Most people think about collaboration as a hospitalist partnering with a large, multi-specialty physician group. But to be successful, we need to expand beyond this limited view to include schools, retailers, local transportation, businesses and pharmacies all working in concert on a common care plan focused on the patient.

Convenience and Care Plan Compliance

Many Americans have more healthcare resources available to them then they realize. And sometimes, even if they are aware of them, they can’t understand them or do not have convenient access to them. The healthcare industry has taken note, however, and is moving toward consumerism.

Patients want to take an active role in choosing a plan that works best for them, and healthcare providers are using innovative ways to interact with patients like mobile apps and educational campaigns. Wearable technology, in particular, is growing in popularity because it provides another way for patients to stay on top of their fitness and stay connected with healthcare support resources. Data from this technology can help providers improve patient care by collecting insight on patient behavior and offer care plan compliance practices that leads to improved outcomes.

Convenience is required, but organizations should carefully consider how this supports greater care plan compliance and patient loyalty. New risk-based contracts are here to stay and will only grow as the move to pay for value accelerates. Using new technologies has to be linked to tracking and supporting care plan compliance and measuring success across the traditional care delivery network and everything in between.

So in summary, while there is no quick fix to the challenges facing our healthcare and reimbursement system, we’re headed in the right direction if we have strategies that consider and address the critical elements of data-driven cultures, advanced care teams and partner networks, as well as healthcare consumer convenience and care plan compliance. Aligning these areas will no doubt position us all better for true population health.