Report: Are EHRs Meeting Providers’ Needs for Value-Based Care Capabilities?

March 2, 2018
Sixty-four percent of healthcare providers believe EHRs have failed to deliver many critical value-based care tools. What's more, 60 to 75 percent are seeking third-party solutions outside their EHR for VBC solutions.

The electronic health record (EHR) market is maturing at the same time that value-based care has grown more permanent roots. When it comes to moving forward on value-based care initiatives, are EHRs up to the task?

An online survey of healthcare executives, with 87 percent of respondents identified as C-suite leaders, found that about two-thirds say EHRs have failed to deliver better population health management tools, and about half claim they would be willing to switch EHRs to get these capabilities.

As the inpatient EHR market begins to consolidate, Sage Growth Partners, a Baltimore-based business management consulting firm, conducted an online survey of 100 healthcare executives to understand their perspectives about what EHRs can—and can’t—do well to give them what they need in today’s environment. The survey aimed to get healthcare executives’ view on value-based care capabilities and limitations. In addition to the online survey, SGP also conducted qualitative research through interviews with six healthcare leaders.

A report based on those survey findings and interviews highlights the many challenges healthcare providers face to get what they need to succeed in VBC contracting. Many healthcare providers have received a return on investment (ROI) from their early forays into VBC; however, beyond quality reporting, most are missing critical capabilities that would allow them to undertake more advanced VBC.

To get these essential VBC capabilities, healthcare providers are looking beyond their EHR and layering on third-party PHM solutions designed expressly to help providers meet the requirements of VBC. One key finding from the survey is that the EHR market is maturing, as 70 percent of providers have had an EHR for at least three years and roughly half also have third-party PHM solutions.

The survey also found that general EHR satisfaction is greater than satisfaction with EHRs’ ability to deliver the capabilities executives need to succeed in VBC. About three-fourths (74 percent) of healthcare executives say they are highly satisfied or somewhat satisfied with their EHR system. This may reflect a growing level of satisfaction with the basic functions of EHRs. However, respondents’ level of satisfaction diminishes when asked about their EHR’s ability to support value-based and population health management programs and initiatives, as only 53 percent of respondents said they are highly satisfied or somewhat satisfied with their EHR’s VBC functions, according to the study.

By and large, providers’ VBC needs are not being met. Sixty-four percent of providers said EHRs have failed to deliver many critical VBC tools. Only a quarter of respondents believe that their EHR can deliver on core KLAS criteria for VBC. And 60 to 75 percent of providers are seeking third-party solutions outside their EHR for value-based care solutions.

However, at the same time, EHRs have traction and the population health management market is unsettled, the report states. About two-thirds (65 percent) of respondents said they are somewhat unlikely or highly unlikely to replace their EHR in three years. This may be due to the steep price tag for these investments—EHRs often top $50 to $100 million for health systems. Conversely, 50 percent of respondents are somewhat/highly likely to switch out their PHM vendor in three years.

Compared to the significant investment in EHRs, investments in population health management tools are modest; 31 percent of providers have a PHM budget of less than $100,000. Another one-third said PHM budgets are $100K to $500, and the last third said their PHM budgets are over $500K. And, yet, three-fourths of respondents (76 percent) said they have realized a return-on-investment with VBC, and 46 percent of these respondents believe that a third-party PHM solution beyond the EHR was critical to success.

Drilling down into the EHR market, the report authors note that the market is maturing but still fragmented, especially in outpatient settings and rural areas, where many health systems and IPAs are still dealing with dozens of different EHRs. The top three EHR vendors among respondents are Epic (42 percent), Cerner (20 percent) and Allscripts (17 percent).

Nearly half of respondents (47 percent) report that they use third-party PHM tools or vendors to help them with VBC functions such as aggregating data, risk stratifying populations, and coordinating care. Usage of third-party tools varies by type of organization; nearly all ACOs and most IDNs, multispecialty physician groups, and clinically integrated networks (CINs) are using them, while single-specialty groups are less likely to have them, according to the report.

To date, large EHR vendors lead the way, with the top-reported PHM vendors being Epic (24 percent), Optum (11 percent), Athenahealth (9 percent) and Cerner (8 percent), the report found.

The VBC Landscape

All of the survey respondents say they participate in some type of value-based or risk-based programs. While over half of organizations get less than 10 percent of their revenues from value-based contracts, most are reaping rewards from their efforts despite the fact that their EHRs’ VBC capabilities have been disappointing. ACOs are by far the most widespread type of VBC program (72 percent), followed by participation in the Bundled Payments for Care Initiative (BPCI) (30 percent), the Comprehensive Joint Replacement program (CJR) (23 percent) and the Comprehensive Care Plus program (CPC+), 15 percent.

The survey respondents also identified the top five VBC challenges that they are currently facing—interoperability, cited by 42 percent of survey respondents; addressing social determinants of health (SDoH), cited by 34 percent; engaging patients, noted by 32 percent; coordinating stakeholders, identified by 30 percent, and having the necessary data analytics to support risk-based contracts, noted by 27 percent of respondents.

What’s more, there are gaps between many of the key proficiencies healthcare providers need for VBC and their satisfaction with their current capabilities. They consider care coordination the most necessary capability (identified by 83 percent as a needed capability), but only about half are satisfied with their current ability to perform this function. In addition, 70 percent of respondents identified timely integration of clinical and financial data as a needed capability, but only 48 percent are satisfied with their current ability to do this.

Other capabilities identified include population health analytics (69 percent identified, only 40 percent satisfied with current capabilities); risk stratification (67 percent identified, only 41 percent currently satisfied); data aggregation from disparate EHRs (67 percent identified, only 41 percent currently satisfied) and patient engagement (66 percent identified as a needed capability, only 39 percent satisfied with current capabilities).

Quality reporting is the only key area where most executives are satisfied with their existing capabilities, the report states.

Most healthcare executives say they are using or are seeking solutions outside their EHRs to get the value-based care functionalities they need. Sixty-eight percent of respondents either currently use or are actively seeking a third-party solution for risk stratification—almost half (45 percent) use a non-EHR solution today, another 23 percent are actively seeking one. Sixty-three percent use a non-EHR technology solution for data aggregation or are actively seeking one. What’s more, 59 percent are using a non-EHR solution for quality program optimization, 15 percent are looking. Close to half (44 percent) are using a non-EHR technology platform for patient engagement, 28 percent are looking. Many healthcare executives also say they are using non-EHR solutions for population health management analytics (40 percent using, 22 percent looking) and for social determinants of health data (32 using, 32 percent are looking).

The SGP report authors conclude that having the right tools to manage VBC contracts is increasingly important. “Executives are finding that the tens of millions they have invested in their EHRs aren’t sufficient to manage such contracts. Most respondents are dissatisfied with their EHR’s ability to help them manage core functions necessary to succeed in VBC – such as care coordination, risk stratification, decision support and patient engagement. And roughly two thirds or more see EHRs as failing to deliver on their promises of lower costs, better PHM tools, and better patient and physician satisfaction,” the report authors wrote.

As a result, half to two-thirds of leaders are turning to PHM or do-it-yourself solutions outside their EHRs to compensate for the lack of these capabilities within their EHRs, and many credit their PHM solutions for enabling their VBC success, the report authors wrote.

And, while respondents report that VBC contracts today represent the minority of their revenues – typically less than 10 to 25 percent of revenues – that isn’t expected to last. VBC reaches the tipping point, and as healthcare providers take on programs with greater risk and greater complexity, they will need to continue looking beyond their EHRs to get the functionality they need.

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