How Hospitals Invest in Health IT for Value-Based Care

September 23, 2019 - The healthcare industry has seen a shift in recent years from fee-for-service payment models towards value-based reimbursement. This shift represents the industry’s trend towards focusing on high-quality care rather than high-volume care.

While value-based care can improve overall patient outcomes, hospitals assume more risk than with traditional fee-for-service models. This increased risk has led many hospitals and health systems to adopt IT tools that help improve workflow and interoperability to better track and manage care in order to maximize the potential for success.

If hospitals and health systems are to adapt to the changing landscape, they need proper tools to manage complex payment models.

Population health management, health information exchange (HIE), and business intelligence tools are critical to effectively managing value-based care delivery. These technologies provide hospitals with the tools to understand how care is being delivered in their hospital, inform quality improvement strategies, and assess financial feasibility. With IT infrastructure to support all three tools, hospitals are more likely to succeed in value-based care models. 

Population health management tools

To address the needs of their patient population, hospitals must analyze the health status of their population regularly. Population health assessment allows hospitals to understand which services are most underfunded, which patients are likely to seek care more frequently, and which chronic conditions are most prevalent for better population health management.

Strategies for population health management can include calculating utilization metrics, risk stratification, and chronic disease surveillance.

According to Definitive Healthcare data, 48.9 percent of all hospitals reported utilizing a population health management tool. Most common among the tools was Epic System Corporation’s Healthy Planet tool, reported by 60 percent of population health management tool users. Other common tools reported included Cerner Corporation’s HealtheIntent (15.3%) and Allscripts’ CareInMotion (6.2%). Overall, 38 unique vendors were reported by hospitals.

In a value-based care setting, these tools can help hospitals find gaps in care and identify high-risk populations to target care interventions.

Interoperability and HIE tools

HIE allows for interoperability of healthcare data — helping enable care coordination and achieve positive outcomes. In a value-based care setting, robust information sharing allows different systems to communicate and share actionable data.

Most executives believe interoperability is crucial for value-based care practices, and 73.4 percent of hospitals report having the technology for HIE and interoperability. According to Definitive Healthcare data, the most common amongst the products used is Epic Systems Corporation's Care Everywhere, accounting for 50.4 percent of the interoperability tools used.

Cerner Corporation and MEDITECH were other commonly used vendors for interoperability tools, accounting for 17.3 percent and 6.5 percent of the tools respectively. Hospitals reported over 80 unique vendors for HIE and interoperability tools.

HIE and interoperability platforms allow providers to share patient medical information through a secure exchange network. This often can occur regardless of the underlying electronic health record system so a provider can see every encounter the patient has had. A more complete picture of the patient population can help providers better coordinate care. Identifying gaps in care and working to close these gaps can help hospitals improve the quality of care they deliver — a staple in value-based care.

Business intelligence and financial performance tools

In order to capitalize on quality improvement opportunities, hospitals must first understand quality metrics and internal performance indicators. Monitoring these metrics allows hospitals to understand how they are currently performing, identify gaps in care, and work towards quality improvement strategies. Such measures can include readmission rates, timeliness of care, and patient safety.  

Many of these quality metrics are linked to financial incentives, so the ability to connect this information to financial data is critical if hospitals want to optimize their reimbursement potential.

In total, 67.5 percent of hospitals report having IT tools for business intelligence and financial performance, according to Definitive Healthcare. Most commonly reported was Epic Systems Corporation’s Caboodle, accounting for 20.4 percent of all hospital’s business intelligence and financial performance tools. Other common tools included SAP’s Business Objects (15.1%) and Change Healthcare’s Performance Analytic Explorer (8.8%). Overall, 71 unique vendors were reported by hospitals.

Business intelligence and financial performance tools help hospitals manage key quality metrics and focus on gaps in care and high performers. These measures are essential for value-based care and inform reimbursement models.  

Optimizing technology to succeed in value-based care delivery

To achieve success in a value-based care model, hospitals should properly utilize tools that aid in population health management, interoperability, and business intelligence/financial performance. The capabilities of all three tools define successful value-based care strategies. Hospitals with IT infrastructure in place to manage all three components are best prepared for the requirements of popular value-based care models.

According to Definitive Healthcare data, only 36 percent of hospitals currently have the IT infrastructure in place to manage all three components of successful value-based care. Nearly two-thirds of hospitals do not have the necessary tools for successful value-based care. While twenty-nine percent report having two of the three tools, 12 percent of hospitals report not having any of the tools for successful value-based care.

Without such tools, hospitals can struggle to manage their data properly, identify gaps in care, target quality improvement projects, and identify high-risk patients. Developing the infrastructure to manage all three components can lead to overall better patient care and more success in the value-based care market.

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Interested in learning more about the future of value-based care? A recent survey, polling 1,090 healthcare leaders across the provider, biotech, financial services, life sciences, and IT verticals reveals predictions for the future of value-based care in 2019 and beyond. Read more here: https://blog.definitivehc.com/value-based-care-2019-survey-results