Because Steven Waldren, M.D., heads up the Alliance for eHealth Innovation at the American Academy of Family Physicians, he has a great perspective on the data needs of practices in relation to the shift to value-based care. He shared some pain points during a Nov. 20 webinar put on by the eHealth Initiative.
Issues with data liquidity and quality will make the transition to value-based care difficult, Waldren said, “but the horse is out of the barn, and we will move toward value-based payment no matter what.”
He said that from a practice perspective, the shift does not involve tweaking a few workflows or checking a few new boxes in the EHR. “For many practices it is a fundamental transformation,” Waldren said. He walked attendees through some of the capabilities required of practices and the associated data needs.
Risk-stratified, active care management: Providers need to classify attributed individuals into groups based on identifying them as high-, medium- and low-risk, and establish strategies for working with each group. “You have to think about these groups very differently,” he said, because you do not have enough resources to be highly interactive with every patient, and it would be counter-productive to be more proactive with very healthy patients.
Waldren said that in order for practices to be effective at care management, their data must be timely and accurate. Clinicians have to stop putting data into EHR just as a note or for billing purposes and think of it more as an asset to run analytics and inform them on how to take care of a patient. The data also must be robust and predictive, he said. Providers need help determining who is moving toward being high-risk so they can intervene early.
Waldren noted that care coordination across practices and settings requires distributing data across the medical neighborhood, and clear roles and responsibilities for a care team. What is happening to your patient in other care settings is important, he said.
“Interoperability is critical,” he said. “We need to have utilization information sent around and a shared care plan so everyone is on the same page. We need to think about more robust communication between teams. To have more of a team-based approach, more constant communication is going to be important. We need task management and tracking across multiple organizations and EHR vendors, and that is a daunting issue.”
Another key to value-based care is patient engagement. Providers need to empower patients to take an active role in their care. Most practices have turned to a patient portal as their No. 1 modality for this. But Waldren pointed out that with open application programming interfaces, it is possible that the patient will be able to pull data from their provider portals rather than having to be tethered to them. Then the patient’s personal health record could amalgamate all their data in one place. That approach has challenges of its own, including semantic ones. The PHR system would have to stitch that data together, not just in a longitudinal way, but pulling together the medication lists from across four EHRs.
Waldren mentioned that remote patient monitoring, secure messaging, and patient-generated health data are important but all raise questions around how the data gets integrated into the patient record.
Access and continuity are also key issues, he said. If providers turn to telehealth providers or on-call providers to be available 24x7, how do you ensure that patient data flows with them across a health system? Do you give after-hours providers full access to the EHR? Or to summaries of care? Do you want them to query against your system or against a local HIE?
“Transitions of care is another key component,” Waldren said. “We have been working on it for a decade, but we have not done a good job of making sure that summary of care can move with the patient.”
Providers need IT tools to manage their own performance improvement. You need a dashboard to triage your measurement of what you are doing well and what not, he said. You need robust analytics to calculate measures, and you need the ability to drill down. You also need access to data outside your practice, such as lab data and medication adherence. In the primary care arena, you need to track that mammograms or colonoscopies are being done.
“We need to focus on automating care delivery now,” Waldren said. “It is much more important than billing and documentation. We spent a long time building technology to support billing and documentation. We need to make sure we don’t replicate the same problem of not having the right focus. Our north star needs to be optimized health.”
Physicians need strong health IT systems to deliver value-based care. “Being data-driven is more critical than ever,” Waldren said. “You can’t be successful anymore if you are not data-driven as a practice or a hospital.”