It’s no secret that the United States healthcare system is one of the most expensive in the world. Nearly 25% of the spending involved is considered wasteful, laying out more on administrative costs and less on long-term care than other wealthy nations. Despite the increasing costs of maintaining a country’s health, outcomes of care are worsening. It’s this counterintuitive trend that’s led people to rethink the fee-for-service (FFS) model. In the search for alternatives, there are a lot of eyes on an approach called value-based healthcare (VBHC).
One of the lesser known provisions of the Affordable Care Act (aka Obamacare) was its establishment of the Center for Medicare and Medicaid Innovation (CMMI). Obamacare created and then tasked this organization to develop alternative payment models for healthcare with an eye toward bringing down costs.
The easy part was determining what caused costs to skyrocket: in a for-profit system that pays for each service provided, there’s an incentive to provide more services, which regrettably, are often not necessary to improve patients’ health but do always seem to benefit the financial standings of the providers and insurance companies. On the other hand, VBHC is rooted in the premise that a system which values the outcome over the service will naturally provide better outcomes for patients.
VBHC incentivizes the actual outcomes for patients
But this is all abstract. Think of it like this: you’ve never gone to the doctor because you had a hankering for a throat swab. If you got a throat swab, it was because your tonsils were swollen and you went to your doctor to fix that problem. Even if you have no other symptoms of strep throat, there’s an incentive to rule it out with that test. You might even be given an antibiotic, just in case, a practice which has its own set of implications beyond cost.
VBHC flips the script here and incentivizes the actual outcome. Without any other symptoms, your doctor knows that a simple salt-water gargle will relieve discomfort and prevent the worsening of infection. In a few days your tonsils feel better and your doctor gets paid for helping you, not for testing you.
But it doesn’t stop there. Because VBHC is focused on lowering costs over the long term, doctors are incentivized to really get at the root of the problems. In this case, maybe your sore throat was due to a smoking habit. If they can get you to quit, that improves more health markers down the road, providing even more value from that one visit. Greater value means bigger payments. This is all a very simplified explanation of a basic health concern, but the general concept remains true. When you start getting into more serious ailments requiring the care of multiple specialists, value-based healthcare can get very complicated.
Why timely data is crucial in a value-based healthcare system
Medicine has always been a practice rooted in data. Every time a treatment is successful, that instance becomes another data point validating the efficacy of the treatment. The fee-for-service healthcare model places great importance on this historical data, often at the expense of what’s happening at the moment. Back to our sore throat: though all but one of the signs of a strep infection are nonexistent, the historical data dictates that a throat culture is in order. The millions of cases that came before this one say it’s the best course of action, even if the data right in front of your doctor’s face says a culture is a waste of time and resources.
Value-based healthcare doesn’t dispense with the wisdom of the past, it just provides greater flexibility to leverage present day intelligence, as well. It empowers doctors to take a more holistic approach to treatment, to find the chief cause of a problem. Your headache isn’t the result of an aspirin deficiency, and VBHC provides a framework for medical practitioners to make informed decisions about diagnostics and treatment using all the information available at a given time. Especially for more complicated illnesses, this can only truly work when a patient’s chart is current, with up-to-the-minute data.
EHR interoperability remains a challenge for health record data
For decades, electronic health records (EHR) have been viewed as an important part of improving patient care. And while nearly all US hospitals and physicians’ offices have installed some kind of EHR/EMR system, not enough of them did so with an eye toward sharing patient data. This is no more clearly illustrated than when examining the lack of interoperability between many of these systems (read the first part of this blog post series here to learn more).
To compound the issue, 43% of rural hospitals still rely on fax and snail mail to send and receive patient records despite having an EHR system to store those records. These organizations still have the extra step of processing faxed and mailed documents before treating patients. All of the information contained in these records has to be extracted from the physical page and entered into whichever digital system of record is in use.
For health information managers already struggling with interoperability issues, starting to think about what needs to happen in preparation for VBHC can be overwhelming. Nothing is written in stone, however, and this new model of healthcare is just in an exploratory phase. If they’re already dealing with staff burnout in a fee-for-service world, the increased data demands of value-based care sounds like a tomorrow problem—if it even happens at all.
VBHC: It’s happening
The bad news for those HIMs that are just avoiding thinking about a whole new healthcare paradigm is that it appears to be an avoidance of the inevitable. While the specific form a VBHC system might take is still being worked out, the wheels seem to be in motion for the move away from our fee-for-service model. The federal agency CMS (Centers for Medicare and Medicaid Services) aims to have all Medicare—and most Medicaid—beneficiaries enrolled in some kind of accountable, value-based care program by 2030.
Meanwhile, its adoption is growing out in the private sector: 60% of healthcare payments in 2020 were calculated using some kind of quality or value component, up from 53% just a few years earlier. A 2022 survey of family medical practices found 49% of them participating in value-based payments systems.
There’s also good news, though: HIMs that are focused on solving their present-day interoperability issues are at the same time setting themselves up for success in a value-based care system. The goal of interoperability is to provide for the frictionless sharing of patient data between providers and organizations. That’s also the prerequisite for value-based healthcare, so addressing that problem today can help solve it for tomorrow.
Managed service delivers complete, accurate data in a timely manner
Our HIPAA-compliant managed service for medical records indexing is already bridging the paper-to-digital gap for organizations without the need to implement any extensive new infrastructure or software. If you’re a health information manager, you already know the importance of patient data—and how crucial it is to be able to share it.
As we move toward a future where that data is an integral part of getting paid, the issue of interoperability with other organizations’ systems is not going to go away, and the need to make complete, accurate data available in a timely manner becomes ever more important. In an environment where healthcare staff is already overwhelmed with documentation, automating that process can provide some much-needed relief.
To better understand how our service can solve your present day problems while setting you up to succeed in the future, download and read our white paper or contact us for a chat with one of our experts.
