- The only constant in the healthcare industry is change, but many providers are still working on their ability to keep up with the latest developments in population health management, value-based reimbursement, health information exchange, and EHR use.
With new regulations and political uncertainty constantly crowding in on efforts to develop accountable care organizations, contract with payers, architect outcomes-based care management strategies, and implement advanced big data analytics, hospitals and health systems are increasingly finding that it simply doesn’t pay to go it alone.
The Health Network of Missouri (HNM), a coalition of six independent health systems serving patients across the state, believes that success with value-based reimbursement depends on working together to share the burdens and benefits of changing payment structures.
Backed by Cerner’s HealtheIntent data exchange technology, the collaboration is actively working to develop the communication tools that will allow them to improve outcomes, lower costs, and successfully navigate the transition to value-based care.
“We have tried to figure out the best ways to work together as we move into a more highly competitive environment,” said Tom Tisone, Executive Director of HNM.
“As we move from fee-for-service to value-based care, we have to recognize that there will be reimbursement changes that prioritize improved access, decreased costs, and better outcomes. It is definitely our goal to figure out how we can achieve the Triple Aim together.”
But with all six member organizations using different electronic health record systems, and some even using different vendors for their inpatient and outpatient operations, implementing the data exchange infrastructure that supports value-based care was no simple prospect.
“Working with multiple EHRs can be very complex and difficult when you’re trying to exchange data,” Tisone acknowledged. “That’s not to mention the fact that some of the physician groups are not using EHRs. Some providers in the very rural areas of the state don’t even use email.”
The only technology in common across all stakeholders was the fax machine, he added, which can be prone to glitches, not optimally secure, and leaves providers with reams of paper to scan or copy into electronic formats.
“We agreed on the common data sets that we would share back and forth via fax, but quite often you would send a patient to a different provider and you would never hear anything about what happened to them there,” said Tisone. “The processes simply were not in place to encourage data sharing, which was very problematic for coordinating care.”
“We thought about connecting our EHRs together, but because there were so many different systems in use, the conversation quickly evolved to working with an EHR-agnostic platform where we could aggregate data and didn’t have to develop each system individually.”
Cerner and its competitors in the EHR developer space have been working hard to make their vendor-agnostic health data exchange platforms an attractive option for providers who wish to leapfrog the hit-or-miss process of building or connecting to a regional health information exchange network.
As a leading member of the CommonWell Alliance and a new partner of the Carequality framework, Cerner has joined Epic, athenahealth, Allscripts, and other top names in publicly committing to seamless interoperability for providers no matter which software they use.
“Health information exchange between providers is about promoting the common good,” said John Glaser, Cerner’s Senior Vice President of Population Health Management. “It’s about developing the methodologies for going beyond basic data exchange and being able to work collaboratively to manage the health of populations.”
“The continued evolution of data exchange, whether it’s through a third-party HIE organization or a vendor-centered effort, is really important. Information exchange has been pretty uneven up to this point, but the emphasis on bundled payments and population health management is a very strong motivator that will help the industry overcome the fragility of prior data exchange models.”
Responding as nimbly as possible to the motivations of the value-based care transition now will prevent organizations from crumpling under the strain of trying to catch up later, Glaser added.
“One of the things we see across our customer base – and I doubt we’re the only vendor experiencing this – is the belief that providers are still largely in fee-for-service, even if they have a modest amount of risk-based reimbursements,” he said. “But they are seeing 2018 and 2020 as the inflection point for value-based care, which is an idea that CMS has been heavily promoting. That means things are going to have to change very quickly.”
“Now they have to keep people healthy and coordinate care across the continuum, and they have to look at data from lots of different sources that may be saying lots of different things. It’s really a very new way of approaching care, and there is a huge skill gap out there that we need to fill before we can get over the confusion and frustration of value-based models.”
HNM is working together to close those gaps as the pressures of population health management start to mount. Each organization still operates as an independent business, however, which can throw a wrench into the process of building enthusiasm for achieving communal goals.
“We are still competitors, and we recognize that,” said Tisone. “When we started these discussions, we did need to build the trust between the leaders sitting around the table – and then that attitude has to filter down to all the folks who were actually going to implement these strategies.”
“The biggest hurdle is always defining that shared vision. We had to ask ourselves why we needed to get together and how our individual visions combined to create a shared roadmap that would benefit from collaborating across business lines.”
Despite the fact that value-based care theoretically rewards all participants for collaborating to improve outcomes, it is no surprise to Glaser that individual healthcare organizations often fiercely protect their own interests as they negotiate with prospective partners.
“Every organization has to ask what’s in it for them. They’ve got a business to run,” he said. “Whether they’re for-profit or non-profit, they still have a responsibility to their bottom line, so it has to be very clear how a collaborative effort will benefit that.”
“In value-based care, either everyone benefits or no one does. That’s a hard idea to swallow. Honestly, if I didn’t need you to help improve my patient’s outcomes, I probably wouldn’t bother working with you. But we all need each other in the value-based environment, and that means we have to collaborate in good faith.”
HNM’s shared technology investment shows that the group has largely gotten over that first hurdle, but there are still plenty of challenges to come.
“We are still dealing with some of these issues as we get deeper into these data sharing and patient management projects,” Tisone said. “We need to continue to refine our communication strategies for people who are going to be impacted by these types of collaboratives. It has to be stated over and over throughout the organization so that the staff really understands why we’re starting to do things differently than we had been doing before.”
And with 1200 affiliated physicians all with different levels of health IT skills, generating engagement across the entire network will take continued commitment to the cause.
“The majority of organizations are receiving this very positively,” said Tisone. “They’re looking for their hospital partners to help move them into the modern health IT world. They might not have the resources or the skill sets to complete these changes on their own, but that doesn’t mean they don’t want to move forward.”
Tisone hopes that encouraging physician practices and their parent organizations to take advantage of HNM’s new data sharing capabilities will help them showcase their their value to payers and patients alike.
“We want to demonstrate to our partners that we can achieve results from a cost utilization and quality perspective,” he said. “We would like our payers and contractors to view us as a preferred network of providers. The ability to coordinate care across multiple entities is a very important part of that.”
Tisone and Glaser both expect that HNM’s improved data exchange capabilities will serve as a strong foundation for continued collaboration and a greater reliance on value-based reimbursements in the future.
“The greater the number of participants moving data around, the greater the benefit to everyone involved,” Glaser said. “If you can achieve critical mass in a community, then you can eventually grind your way through all of the issues about who is going to fund what and how much each organization has to contribute, because you’ve established that the motivation to succeed is stronger than the very human desire to retreat from risk and protect your own interests at all costs.”