Existing and Emerging Technologies to Advance Value-Based Care

June 17, 2019 - Value-based care requires an unprecedented amount of health data exchange and analytics, and many providers are hesitant to adopt these new forms of care delivery and reimbursement because of internal or external technical limitations, primarily interoperability.

Last year, a follow-up Humana-HFMA study on value-based payment readiness found interoperability to be a critical focus among the majority of 117 senior hospital financial executives surveyed. Nearly three-quarters of respondents (74%) cited the ability to aggregate and share information as an extremely important need over the next three years.

That figure increased from 68 percent during the original study in 2015. “Additionally, half of respondents in the 2017 study describe interoperability improvement across health networks with health plans as extremely important,” they noted.

“Transformation of the nation’s healthcare payment system is being slowed by limited capabilities for sharing clinical information among hospitals, physicians, and health plans,” the two organizations concluded.

More than half of respondents reported being somewhat capable in the areas of external (59%) and internal (57%) interoperability. This lack of interoperability is affecting the ability of providers to improve their work with data, as the majority of stakeholders had limited capabilities regarding care standardization (59%), chronic care management (57%), real-time data access (54%), post-discharge follow up (52%), and business intelligence (51%).

“Anecdotally, there is some slight evidence that problems with interoperability are anticipated to be most problematic,” the report stated.

Payers are uniquely positioned to help their provider partners overcome a lack of interoperability and leverage improved data access to manage their patient populations more effectively. But bridging the gap from fee-for-service to value-based care will require the evolution of technologies to support delivery models based on utilization and outcomes.

A promising future for value-based care technology

The majority of providers and health plans from an annual survey conducted by Quest Diagnostics agree that certain technologies have the greatest potential to improve the effectiveness of value-based care models based on data.

Artificial intelligence & machine learning: Possibly the technology with the greatest potential to change healthcare is artificial intelligence. A subset of AI, machine learning is already demonstrating the ability to speed diagnostic processes for identifying and treating cancer for radiologists and pathologists.

Truly intelligent systems will benefit from the early application of artificial intelligence in healthcare. Many healthcare leaders have already identified numerous use cases where the technology can address current business challenges, many of which are applicable to value-based care.

AI can provide insight into the design of intuitive user’ interfaces to improve clinical documentation, a vital source of quality data for providers and payers. The technology could also assist with order entry and fulfill routine requests that require a clinician’s attention.

Healthcare artificial intelligence could also analyze the streams of data coming from EHRs, medical devices, and remote patient monitoring systems to alert providers and payers to the need for intervention. Chronic disease management would receive a significant boost thanks to the ability of computers to parse massive amounts of data for subtle variations imperceptible to the human mind that can help close care gaps.

Bioinformatics: This emerging technology uses computer technology to manage and analyze large volumes of biological information (e.g., genetics) for the development of effective treatments.

“Computers are used to not only store, but also gather, analyze and integrate biological and genetic data that can then be applied for such uses as gene-based drug discovery and development,” according to University of South Florida Health.

As the academic medical center notes, knowledge gained through bioinformatics can lead to the development of new drugs and therapies and support for preventative medicine, the latter being especially vital considering the volume of healthcare spending historically tied to disease and the goal of value-based care to drive prevention.

Blockchain: Secure data sharing between payers and providers is essential to value-based care. But one-off solutions that enable data exchange (e.g., interfaces) are far too manual to be scaled.

Blockchain provides the validation that the healthcare industry needs, and it delivers that service in a way all parties can trust.  No single entity oversees holding the data, yet all participants are responsible for ensuring data integrity and security. If no one can change the record without all stakeholders signaling approval of the edits, and no unauthorized party can access the health record without the participants giving collaborative permission, the healthcare industry can avoid two of its most dangerous big data risks at the same time.

Earlier this year, Aetna, Anthem, Health Care Service Corporation (HCSC), PNC Bank, and IBM announced a new blockchain collaborative to enhance interoperability and transparency in healthcare. More than a year ago, Humana, MultiPlan, Optum, Quest Diagnostics, and UnitedHealthcare unveiled a cooperative blockchain pilot program to improve data quality and reduce administrative costs around provider data management. 

Healthcare professionals and consumerism long for a care experience that mimics the conveniences made possible by application programming interfaces (APIs) and the app ecosystems that speed adoption by end-users.

Solutions to support value-based care today

Artificial intelligence, bioinformatics, and blockchain should prove instrumental to accelerating the evolution of value-based care in the years to come. But payers need solutions now to address the most significant obstacles in the way of effective population health, the ability to exchange high-quality data with providers.

Thanks to the adoption of certified EHR technology and industry-led efforts to leverage health IT standards, providers and payers have access to existing technologies that allow data to move between stakeholders in a secure and automated fashion.

By leveraging HL7 clinical document architecture (i.e., the standard specifying the structure and semantics of clinical documents), health plans can access clinical data in a machine-readable Extensible Markup Language (XML) format. Likewise, technology is available to payers to export unstructured data in Portable Document Format (PDF) or Rich Text Format (RTF) files. As a result, plan can reduce and even eliminate chart pulls and reviews and access a rich data set for designing benefits and ensuring provider and patient compliance. These direct connections eliminate manual processes and free resources to focus on improving care coordination and outcomes.

What’s more, payers are leading efforts to support API-enabled innovation specifically for value-based care. For instance, the HL7 Da Vinci Project comprises members for the nation’s leading payers and technology companies focused on using Fast Healthcare Interoperability Resources (FHIR) to enable the efficient exchange of clinical data in a timely, appropriate, and secure manner. Two use cases — data exchange for quality measures and coverage requirements discovery — are slated for a 2019 release while four more are under active development.

Improving the quality and cost of care in value-based care is not possible without robust information exchange. By investing in technologies that ease access to and analysis of data, providers and payers can truly drive spending on services and treatments most likely to lead to optimal outcomes.

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VeradigmTM – Transforming Health Insightfully

Veradigm is an integrated data systems and services company dedicated to simplifying healthcare with next-generation health insights and technologies.  Our solutions are designed to help increase efficiency, manage costs and improve outcomes for health plans and other healthcare stakeholders.  To learn more, visit www.veradigm.com.