Overcoming Obstacles in Value-Based Care Adoption

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Potential actions that can accelerate the transition

The promise of value-based care is better patient care, lower healthcare costs and more favorable health outcomes. The reality of value-based care is the challenge of transitioning an entire industry from fee for service to models of care that reward higher quality.

The  health plans, hospitals, ACOs and physicians who successfully navigate this transition stand the greatest hope of leading a new era of healthcare service delivery. Many are struggling to make the switch.

So what are the obstacles that stand in the way of adoption of value-based care? Can health plans, health systems and physicians do things differently to speed this adoption? These are the questions a joint study by Quest Diagnostics and Inovalon recently set out to answer. Specifically, it asked physicians and health plan executives how they perceive progress toward value-based care and the challenges that still lay before them.

The study, “Finding a Faster Path to Value-Based Care,” showed that physicians and health plan executives hold starkly different perceptions about the importance of and impediments to value-based care adoption. Reconciling these differences in perception – and seeing what’s really happening at the point of care – provides a path forward.

First, the study shows that value-based care is far too complex. Physicians are expected to stay on top of multiple quality scoring systems, risk adjustment models, reimbursement rules, incentives and penalties. Our survey suggests this expectation is unrealistic.

Second, physicians in the study agreed that lack of access to patient data at the point of care is a hindrance to quality care. They also said the information necessary to make informed decisions isn’t sufficiently aggregated and organized for them when and how it’s needed – namely, at the point of care. The lack of interoperability among systems, where a single patient’s records exist across silos, only exacerbates these challenges.

Complexity and inadequate access to patient data are not insurmountable obstacles, however. The study points to areas that health plans, health systems and physicians that can take to drive positive changes moving forward.

Ensure Quality Measures are Top of Mind

Three quarters of study respondents agreed that quality measures are useful in helping to improve care. This is a good start, but only half of that same group agreed that quality measures set under value-based care models are top of mind when physicians meet with patients.

Developing processes and tools that help physicians consider the measures they must meet – while with the patient – is critical to maximizing quality and financial incentives.

Reduce Complexity

Nearly three quarters of all respondents agreed that quality measures are too complex, which makes it difficult for physicians to achieve them. And nearly  80% of all respondents agreed that physicians do not know the quality metrics that apply to individual patients – these are quality metrics that would presumably allow them and their practices to qualify for financial incentives under value-based care models.

Health systems that can help their physicians pull this critical information forward would do themselves and their organization a great service.

Improve Access to Patient Data

Ninety percent of all respondents also agreed that lack of access to patients’ medical information at the point of care can negatively affect outcomes. Yet only 34% of physicians in the study said that have all the healthcare information they need about their patients. Both physicians and health plan executives agreed (78%) that a leading cause of inadequate data access is because patients can have many physicians that may not share information across EMRs or other channels.

Lack of interoperability (74%) and integration into current workflow (37%) were also cited problems. Technologies that can connect these disparate streams of data to provide a holistic view of the patient are sorely needed.

Better Technology Needed and Wanted

There were some bright spots in the survey. Eight-five percent of physicians in the study said they are likely or very likely to use a tool that provides on-demand patient-specific data to identify gaps in quality, risk and utilization as well as medical history insight within the clinical workflow in real time, assuming it was available. This is a significant finding because it suggests that physicians want tools to help them achieve value-based care.

Notably, 44% of health plan executives said physicians have access to such tools, but only 29% of physicians said they did. Clearly health plan executives may not understand the extent to which physicians are hindered from accessing technologies, such as data analytics, that can help them deliver care – at the point of care—that is aligned with quality, outcomes, and other metrics.

While issues around complexity and incomplete access to patient data aren’t new, the Quest Diagnostics and Inovalon study shows that the industry must work harder – and collaboratively – to ensure physicians are empowered to deliver value-based care. Heightened focus on quality, less complexity and access to data are needed at the point of care.

The health organizations that can deliver on these needs stand the best chance of adapting to the changing healthcare landscape over the long haul.

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About Author

Harvey W. Kaufman, MD
Harvey W. Kaufman, MD

Harvey W. Kaufman, MD, serves as senior medical director of medical informatics at Quest Diagnostics. In 2015, Quest Diagnostics and Inovalon formed a collaboration to help the healthcare industry use data analytics, such as Data Diagnostics, a point of care analytics solution, to transition to value-based care.

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