Enhancing Data Management for Value-Based Care

The concept of value-based care (VBC) emerged more than 20 years ago in response to concerns about rising healthcare costs and inconsistent quality of care under traditional fee-for-service (FFS) models. In the decades since, it has gained significant traction as the healthcare industry as a whole has shifted to more patient-centered and personalized healthcare delivery.

Still, despite widespread support for value-based care models from payers and providers alike, adoption and implementation continues to fall short. Gaps in data management capabilities play a central role in this challenge. Fragmented systems, low-quality and inaccurate data, access limitations, and resistance to change all make it difficult for healthcare organizations to successfully deliver value-based care.

As a result, they miss out on significant opportunities—financial rewards for achieving specified quality measures, bundled payments, shared savings plans, performance-based bonuses and more. At the same time, patient health outcomes are hindered by issues that are resolvable with the right strategies and support tools.

To realize the full benefits of value-based care, healthcare leaders must prioritize data management and overcome hurdles related to its effectiveness.

Quick Takeaways:

• Effective data management is essential for value-based care, but many organizations struggle to achieve it due to fragmented systems, inconsistent standards, and limited interoperability.
• Key technological advancements to ensure data quality and integrity are crucial.
• System interoperability and real-time data access are critical for seamless care coordination and informed clinical decision-making in value-based care models.
• A holistic approach to healthcare data management, including integrating external data sources, is necessary to fully realize the benefits of VBC and enhance patient care.
  

Understanding Value-Based Care in 2024

In 2024, value-based care continues to redefine the healthcare landscape, driven by evolving regulatory initiatives, technological advancements, and strategic shifts in care delivery. Important developments to stay abreast of right now include:

1. Accelerated Adoption of Risk-Based Models

The healthcare industry is rapidly transitioning to risk-based payment models, such as bundled payments and capitation, that prioritize outcomes over service volume. According to Holland & Knight, this shift is projected to double the VBC market value to nearly $1 trillion. Adoption is growing on the patient side as well—70% of Medicare Advantage enrollees chose VBC providers in 2022, indicating an encouraging alignment between the industry’s strategic direction and patient care preferences.

2. CMS’s Strategic Push

The Centers for Medicare & Medicaid Services (CMS) have played a crucial role in expanding value-based care. The agency’s Bundled Payments for Care Improvement Advanced (BPCI Advanced) and Enhancing Oncology Model (EOM) are two of many examples of programs offering financial incentives for achieving specific health outcomes.

These initiatives align with CMS’s goal to have 100% of Medicare beneficiaries under accountable care by 2030, reflecting a robust regulatory push towards VBC.

3. Consolidation and Integration Trends

Payer and provider consolidation is gaining momentum across the industry as an enabler of value-based care, with standards like the CMS Interoperability and Prior Authorization Final Rule requiring seamless healthcare data exchange and management across the U.S. healthcare system. With these rules in place, even slow technology adopters will need to get on board with VBC-aligned technologies and processes to meet regulatory guidelines.

4. Accelerated Technology Advancements

Data-related technology advancements like automation, analytics, and artificial intelligence are changing the way payers, providers, and patients access and use data in healthcare settings. In order to execute a value-based care strategy, providers must embrace and align with these technology changes to keep their systems and processes relevant and compliant.

Considerations around data privacy, analytics reliability, ethical AI integration, and system interoperability all play a role in a provider’s ability to leverage these tools for VBC delivery.

5. Shift in Care Delivery Settings

The pandemic accelerated the shift from inpatient to outpatient and home-based care. VBC models are adapting to these changes by supporting telehealth and remote patient monitoring, and providers have to get on board in order to deliver value-based care.

6. Patient Engagement

Patient engagement is a cornerstone of VBC. Telehealth, mobile apps, and remote monitoring tools have all enhanced patient involvement and data access. Increased adoption of these technologies empower patients to take a more active role in their health, and engaging patients effectively ensures that they are better informed and more likely to follow through with their prescribed care plans, which is essential for the success of value-based care models.

Data Management Challenges are a Barrier to VBC Delivery

Collectively, the trends covered in the previous section are shaping the landscape of value-based care in 2024 and in the years ahead—and the benefits of aligning with them for more effective VBC adoption are felt by all stakeholders:

• VBC reduces costs for payers through efficient resource use and preventative care, lowering the occurrence of negative events like emergency interventions and hospital readmissions.
• It provides financial rewards for delivering high-quality, value-based care that motivate providers to continually improve care delivery and work toward optimal patient outcomes in all areas.
• VBC enables more personalized, coordinated care, leading to more seamless patient experiences and driving better adherence to treatment plans.

That said, staying aligned with these trends requires comprehensive and effective data management that many organizations still struggle to execute. Data-related challenges hinder their ability to unlock the full potential of value-based care. These include:

Inconsistent Data Standards

Inconsistent adherence to healthcare data standards and varied data formatting and protocols lead to inconsistencies that hinder seamless data flow between payers, providers, and other key players in healthcare ecosystems.

Limited Data Interoperability

Many healthcare systems struggle with interoperability and are unable to easily share healthcare data across different platforms and organizations. This kind of fragmentation can lead to incomplete patient records and disjointed care delivery.

Real-Time Data Access

The inability to access patient records in real time is a major obstacle to value-based care. Healthcare providers often work with outdated or incomplete information that negatively impacts clinical decision-making and patient outcomes.

Inadequate IT Infrastructure

Many organizations lack the robust IT infrastructure needed to support data management for value-based care—things like sufficient storage, cloud technology, modern software systems, data analytics tools and more. They can’t incorporate important aspects of VBC such as accessing external data to see 360-degree patient views, exchange data easily with partners, and gain insight with sophisticated analytics.

Overcoming Challenges to Enhance Value-Based Care

Even with the best intentions and highest levels of commitment to value-based care, it is impossible to achieve when data management issues persist. To close the gaps and deliver quality VBC, organizations must take critical steps that include:

• Master Data Management (MDM): Establishing a unified, accurate view of patient data across the organization to eliminate inconsistencies and redundancies.
• Standardizing Data Formats: Enforcing adherence to healthcare data standards (HL7 FHIR, MIPS Promoting Interoperability Requirements and more) for seamless data exchange.
• Enhancing Data Interoperability: Developing and implementing robust HIE frameworks and APIs to facilitate smooth data transfer between systems and organizations.
• Enabling Real-Time Data Access: Investing in cloud-based solutions and analytics platforms that provide immediate access to up-to-date patient information at the point of care.
• Upgrading IT Infrastructure: Modernizing IT systems with scalable storage solutions, updated software, and powerful analytics tools to support sophisticated data needs.
• Integrating External Data Sources: Developing infrastructure and tools to incorporate external data, such for a comprehensive view of patient health.

These and other important data management enhancements can be cohesively implemented with the adoption of a comprehensive platform to support a full range of capabilities. Gaine’s Coperor Health Data Management Platform does this and more, providing a scalable and ecosystem-wide solution built to address the unique healthcare data challenges and needs.

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