June 28th, 2017

Value-based care: popular in theory, but what’s holding it back in practice?

Health Innovation Think Tank tackles key value-based best practices

Source: HIMSS Media

There’s plenty of discourse and dissent about the future of healthcare in the United States. Value-based care, however, seems to be eliciting support from all corners, according to Jeff Coughlin, senior director of federal and state affairs, HIMSS.

“Everyone is on board with value-based care” as there is both economic and clinical quality justification for the model, Coughlin said during The Health Innovation Think Tank: A Collaboration of Global Health Industry Thought Leaders held on June 22nd at Lenovo headquarters in Durham, N.C.
The challenge, however, rests in overcoming obstacles that stand in the value-based care path, according to some of the approximately 50 healthcare delivery system and healthcare IT vendor thought leaders gathered at the symposium, which was co-hosted by Lenovo Health, Justin Barnes Advisors, University of Pittsburgh Center for Connected Medicine, Inventiv Health and HIMSS Media.
Holly Miller, MD, CMO at MedAllies, Fishkill, N.Y., for example, pointed out that innovative technology only accounts for about 20 percent of the transformation equation with the other 80 percent hinging on process and workflow redesign.
 “In the United States, we have spent 30 billion on the adoption and implementation of digitized healthcare information. We have made progress but we have not really leveraged that investment,” said Miller, who was serving as one of the thought leader “catalysts” at the event. 
Consider the following: One in five patients experience an adverse event after being discharged from the hospital, despite the fact that technology is capable of performing real-time document transfers to primary care physicians. The problem is that such electronic communication only accounts for 20 percent of the critical components of the discharge process. To truly experience value, organizations must heed the other “80 percent,” which includes processes such as discharge medication reconciliation, clinician-to-clinician hand-offs, scheduling an appointment with a primary care provider within three days of discharge and placement of a phone call to the patient within 24 hours of discharge.
Patient identification is another challenge that organizations must address as they share health records across the continuum of care – regardless of EHR. Tom Foley, director of global health solution strategy at Lenovo Health, reflected on the fact that he, like many other consumers, sees various providers and “all of my data is in different locations and they all know me differently.”
As such, when transitioning from one care setting to another, organizations are often besieged with problems such as duplicate medical records, medical identity theft and payment fraud. Unique patient safety identifiers can eliminate these problems by enabling organizations to match patients with records. A unique patient safety identifier is not an alphanumeric value someone can view, but it is an encrypted token that can also be leveraged in a deterministic-matching algorithm that allows healthcare organizations to know with 100-percent confidence they have the right person. These identifiers can outperform other methods such as the enterprise master patient index, which employs probabilistic matching and is only accurate about 80 percent of the time.
While leaders must address issues such as process redesign and patient identification, they also simply need to make the move to value-based care. The fact of the matter, however, is that the majority of care is still delivered via fee-for-service models and many healthcare organizations are not quite ready to make the change.
The situation reminds Leigh Williams, administrator, business systems at the University of Virginia Health System, of an old fishing theory that says a fisherman can catch a large bounty of fish while a storm is coming in, but “you have to do a risk/reward analysis to know when to bring the ship in from the storm.” Indeed, although organizations know that they will need to come in and adopt a value-based model, it is difficult to “pivot because [they] are still catching fish in the fee-for-service model,” she concluded.

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