- The road to value-based care has never been a smooth one, but healthcare providers and payers may be in the midst of a particularly bumpy part of the journey, reveals a new survey from Quest Diagnostics.
Confidence in the transition to pay-for-performance reimbursement is waning as healthcare payers and providers start to come to terms with the fact that data analytics skills are a fundamental requirement for success – and that many organizations are falling far short of their technology goals.
Both health plans and physicians are largely in agreement that care providers simply do not have the tools they need to succeed in a value-based environment.
Fifty-seven percent of physicians and 54 percent of payer executives stated that the healthcare system as a whole is lacking the support necessary to advance value-based care.
This represents a significant increase from the number of stakeholders who felt unprepared in 2017, when 46 percent of payers and 45 percent of providers questioned their ability to move forward with alternative payment structures.
Data is the missing ingredient. While physicians are clamoring for EHR data, clinical decision support tools, and other analytics modules to support more informed decision-making, few providers feel able to access all the data they need to optimize patient care.
Source: Quest Diagnostics
Just under three quarters of survey participants – including payer executives – acknowledged that physicians do not have sufficient access to all the information they need about their patients. Again, this number is higher than it was in 2017, when 60 percent of participants said the same.
This indicates that providers and payers are much more likely to recognize the critical importance of big data for making the best possible choices with their patients.
Only 39 percent of providers believe that they can get all the data they need from their electronic health records. Integrating additional sources of data into the care process is essential for making good decisions, they added, with 86 percent asserting that EHR interoperability would help them provide better care.
Lab data is particularly valuable to physicians, with 88 percent stating that lab results provide insights unavailable from claims and prescribing data, and 84 percent noting that labs are vital for closing gaps in care.
The statistics may seem dismal, but coming to terms with these deficiencies is a positive step for the industry, and may allow both groups of stakeholders to move forward in a synchronized manner.
"While our study suggests the healthcare industry still has a long way to go to deliver value-based care, it reveals avenues to speed the journey," said L. Patrick James, MD, chief clinical officer, health plans and policy, medical affairs, Quest Diagnostics.
"Measures that optimize EHRs, make data more accessible and insightful and reduce complexity of quality measurement are much needed steps to accelerate this transition. First, however, it's clear that health plan executives and physicians need to better align around a shared vision of how technology and data can improve patient care."
Payers are still about 12 percent more likely than providers to believe that their investments in technology have been worthwhile for improving quality, and physicians are still skeptical that payers are in full alignment with their needs and goals.
Yet both are taking similar approaches towards investing in technology in the near future. Payers and providers are significantly more likely to work on optimizing the technologies they have than investing in new ones – and they are doing so at a much higher rate than they did in 2017.
Fifty-three percent of survey respondents are investing in health IT optimization in 2018, compared to just 38 percent the year prior. Only a quarter of participants are investing heavily in new technologies, and a mere 11 percent are undertaking a major overhaul of their technology infrastructure.
Source: Quest Diagnostics
While relatively few organizations are looking to bring new technologies into their environments in the near future, they are optimistic that emerging tools and strategies, including artificial intelligence, FHIR, blockchain, and bioinformatics, have the potential to accelerate progress towards value-based care.
Sixty-eight percent of participants believe artificial intelligence can improve care delivery, and 64 percent think FHIR will help support plug-and-play technologies to improve interoperability and expand the capabilities of analytics tools.
Only 47 percent see a role for blockchain in the value-based care landscape, and those participants mainly hail from the payer side of the table.
Close to two-thirds of payer executives said that distributed health information exchange may help to support data transactions between payers and providers, while only 45 percent of physicians believe that blockchain could enhance interoperability.
"It's encouraging to see that physicians and health plan executives recognize the potential of emerging technologies, such as artificial intelligence and blockchain in healthcare, to catalyze the shift to value-based care," said Lidia Fonseca, senior vice president and chief information officer, Quest Diagnostics.
"That's a positive sign because it means our industry may be more open to harnessing the power of technology and insights from data to spur important transitions – like the shift to value-based care – than it was just a few years ago."
Despite the interest in emerging data-driven technologies, few organizations are likely to adopt a new generation of tools if they do not believe their value-based care goals are within reach.
The overall lack of confidence in value-based care may be a dangerous signal for technology developers and data analytics enthusiasts: one major misstep in such a skeptical environment could set progress back even further.
Organizations and their vendor partners will need to tread carefully when making promises about the benefits of health IT tools, and must ensure that any new implementation or optimization project receives broad organizational support and end-user buy-in to ensure that changes truly support value-based care workflows.
Providers and payers will need to collaborate even more closely around interoperability, data exchange, and sharing data analytics insights if the industry is to push past this slump and continue its journey toward higher quality, lower cost care.