Driven by changes in federal policy, the way in which health care is paid for in the United States is being restructured, shifting away from a fee-for-service, pay-for-volume approach to one that pays for demonstrated value defined as effectiveness of care delivered and outcomes achieved coupled with reduction in overall costs. While stakeholders debate the specifics of various value-based approaches, there is little doubt that the ability of any value-based health care program to deliver on its promise depends on access to technology and data.
In a value-based environment, comprehensive knowledge of a patient’s health status is critical and health care organizations participating in value-based reimbursement arrangements require timely access to appropriate and accurate clinical information, performance measurement and monitoring, clinically meaningful risk adjustment, and transparent, actionable data that capture provider performance.
The shift to a value-based system of reimbursement thus creates opportunities and challenges for both providers and their HIT collaborators ranging from incremental updates to existing electronic health records (EHR) systems to the introduction of innovative new technology platforms capable of advancing value-based health care goals in scalable and cost-effective ways.
- Expanded HIT Solutions. To operate in a value-based reimbursement environment, many health care organizations, including HIT vendors, will need to update or adopt new technology to support changes in claims and payment administration processes driven by alternative payment methodologies (APMs). Modifications or upgrades to existing HIT may also be necessary to support changes in clinical operations such as care redesign and care coordination. Such modifications may include adoption of more expansive and varied HIT solutions ranging from telehealth solutions, patient-facing applications, and more robust data monitoring and analytics tools.
- Smart Data. Expanded HIT solutions are meaningless in the absence of smart data. In order to be successful in a value-based reimbursement environment, HIT solutions must be supported by an active data repository that pools information from multiple sources and delivers actionable information to providers at the point of care. Importantly, more than patient data are needed. In addition to liberating patient data from provider-specific silos, providers across the care spectrum need to integrate all of their data, including financial data and administrative data.
As health care organizations move deeper into the value-based reimbursement environment, existing relationships between and among providers, patients, payers and HIT vendors may need to be revisited and new relationships forged. Future arrangements not only must respond effectively and reliably to the particular demands of the relevant value-based reimbursement system such as applicable reimbursement metrics and reporting mandates, they must also – in both design and implementation – operate within the bounds of applicable fraud and abuse laws and information privacy and security regulations.