As the shift from fee for service to value based contracts begins to take hold, practices like yours are being required to reduce the overall cost of care, while maintaining or even augmenting the quality of care provided to your patients.
In order to be successful in this new payment environment your practice is likely undergoing many changes, new contracts are being negotiated with your local payers, you’re beginning to participate in various federal Advanced Practice Models, care management roles are being defined and implemented, quality initiatives driven by practice guidelines launched and maintained and payment incentives and physician compensation structures are being reviewed, with new emphasis on “value” rather than “volume.”
All these significant changes can only be undertaken successfully in a data rich environment. As your practice assumes risk for the cost of care provided to cohorts of patients, it becomes imperative that you are in possession of timely, actionable, highly accurate, multi-sourced data that supports the clinical, financial and administrative decisions of your practice.
I have had the privilege in the last few months to travel across the country visiting many practices, learning about their value-based journey. I have been incredibly impressed by the degree of transformation and innovation being undertaken by practices everywhere. Many practices are beginning to participate in contracts that include some degree of risk, “upside” risk only and some practices are already deep into fully risk laden, capitated contracts for some of their cohorts.
Data sources available to practices vary greatly, many practices have access to their EMR data only, others have data from state or regional Health Information Exchanges (HIEs), commercial and Medicare adjudicated claims data and several practices are beginning even to grapple with analyzing social determinant data such as, housing eligibility and other socioeconomic markers. It is clear that the richer the data available the more valuable are the insights derived from its analysis. Observing the reluctance of some of the commercial payers to share claims data with practices has been a source of ongoing frustration to me as a physician. It seems so counterproductive to expect practices to become accountable for the cost of care, without providing them the data required to truly understand, and thus impact these costs.
It has been very encouraging to see remarkable outcomes produced by highly motivated practices, combining rich, accurate analytic insights from varied data sources, to drive their decisions, engage their patients while maintaining quality and cost efficiency. At NextGen Healthcare, we’ve developed a sophisticated analytics suite that puts the power of these data within reach for physicians and their teams – these analytic insights are now being fully integrated into EMR workflows to be utilized seamlessly at the point of care.
In the next blog, we will talk about the unintended consequences of multi-source data.