Interoperability for Health Plans: Facilitate the Transition to Value-Based Care | Geneia

Interoperability for Health Plans: Facilitate the Transition to Value-Based Care

September 29, 2016
Heather Lavoie, Chief Strategy Officer, Geneia

Market forces, such as MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and mandatory bundled payments, increasingly drive everyone toward highly coordinated care – care that requires existing data systems to reliably share data back and forth. It requires data to keep up with patient movement through healthcare services, diagnosis, treatments, medications and adherence. It requires data to be interpreted and delivered as insights, into the hands of providers, at the moment they need it.

Data floods us from every direction – multiple EHRs, medical devices, legacy systems, homegrown analytics, wearable devices, multiple databases, data warehouses, and so on. Virtually all of these data systems exist independently of one another, utilizing an array of data protocols and proprietary schemas designed to contain rather than share. As the types of data increase, so do the methods by which is it ingested, exchanged and integrated. These disparate systems must find a way to seamlessly communicate with one another to achieve highly coordinated care.

The High Cost of Disparate Data

These highly isolated and disparate systems lead to tremendous waste for health plans, providers and consumers at the rate of $30 billion per year through:

  • Redundant testing
  • Increased length of inpatient stay
  • Increase length of emergency department stay
  • Drug errors
  • Diagnostic errors
  • Wasted time manually entering and re-entering data

The goal of MACRA is to reduce wasteful spending, while simultaneously improving health outcomes. This value-based reimbursement structure depends on the interoperable exchange of data. MACRA requires health systems to achieve “widespread interoperability” as measured by:

1. Measure 1: Proportion of health care providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding      (querying); and integrating information received from outside sources.

2. Measure 2: Proportion of health care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.”

A Broader Perspective

We believe these measures are a good start. However, a broader interpretation of interoperability must be adopted and applied to all populations and all members InteroperabilityContentPhotoof the  healthcare community to deliver care that improves the quality of people’s lives while reducing the cost and burden of administrative tasks for providers.

It’s time for health plans to openly share their wealth of data, analytics and knowledge. Health plans have deep expertise in aggregating and analyzing complex data and the resources to make it all available to their provider network. The exchange of data alone is not nearly enough. Knowing how to turn data into actions that positively impact the cost and quality of care is key.
Providers, especially those in smaller practices, have significantly less experience with analyzing data and far fewer resources to dedicate to the effort. However, when providers have transparent access to the same underlying data and analytics, they begin to see their work through a new lens. This shift in perspective enables a higher degree of collaboration and a greater impact on the delivery of value-based care.

Drive Interoperability. Drive Success.

Nearly every health plan is engaged in some kind of value-based arrangement. However, like providing raw data, negotiating a contract is not enough. Successful health plans demonstrate their commitment to ongoing collaboration by sharing technologies and expertise with their network physicians.

In any contract, the ability for all parties to measure performance against commitments is fundamental to determining the success of the contract and where to focus improvement efforts. Without a transparent analytical platform, health plans are stuck churning out paper reports with ill-equipped legacy systems and providers are stuck with often-outdated information that focuses more on updating paperwork than improving care.

Value-based care and interoperability are inextricably intertwined – you cannot have one without the other. It’s time to facilitate change and offer an interoperable data and analytics platform to your provider community and share your deep knowledge base.

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