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June 2017

CFO Zone: Technology's Role in a Fee-For-Value Universe
By John Damgaard
For The Record
Vol. 29 No. 6 P. 8

Value-based or fee-for-value health care. These are terms health care professionals have probably heard to the point of exhaustion. Nevertheless, they cannot be ignored, because ultimately they will affect virtually every organization.

As the industry shifts from volume-based care to a fee-for-value model, successful providers will use data to optimize clinical outcomes, producing a higher quality of care at a better price. As reimbursement becomes increasingly tied to outcomes, providers who underperform will struggle to survive.

Medicare's and Medicaid's Role
It's no secret that a growing Medicare and Medicaid population further stresses a provider's viability during this time of transition. According to Plunkett Research, Medicare provided coverage to an estimated 57.1 million seniors in 2016 while national expenditures on Medicaid totaled an estimated $577.7 billion. Additionally, it is projected that 82 million Americans will be covered by Medicare by 2030.

This government payer population growth, in conjunction with the punitive nature of many of the transitional payment metrics being used in the shift to a fee-for-value payment structure, challenges providers even further. In fact, Kaiser Health News recently reported that the government will punish more than one-half of the nation's hospitals for having more patients than expected return within a month of their discharge.

Technology Solutions
In a fee-for-value environment, the overall goal for any health care organization is to maximize overall reimbursement to stay profitable, regardless of outside factors. How does an organization stay competitive in this model? The answer must include technology.

Technology is changing as quickly as the industry itself. It's poised to be the biggest resource to help providers stay successful. Interoperability, big data, Internet of Things—the list of technological advances that can improve health care is lengthy.

However, there are three main factors to harness when utilizing technology to be successful in a fee-for-value payment model: big data, clinical decision support, and care coordination. All three play a crucial role in providing the best quality care a patient can receive.

The biggest opportunity for optimizing these factors through technology is by creating a longitudinal EHR that provides all stakeholders with a global view of what is taking place during a patient's care, whether it be inside or outside of their facility. A longitudinal EHR combines big data, clinical decision support, and care coordination into one point of reference, eliminating the current communication silos that exist in the health care industry. As a result, providers can achieve better patient outcomes and thrive financially in a fee-for-value marketplace.

Better Patient and Financial Outcomes
The opportunity to collect and use more relevant data to make better clinical decisions and enhance care coordination is poised to help an industry that is continually challenged to be profitable. Traditional EHRs are effective at collecting minimal data such as vital signs, allergy lists, and medication histories, but they do not share the data with all of the stakeholders involved in the care process.

Data sharing is needed to foster a higher quality of patient care. The current silos make it difficult to share data, which limits the ability to make more informed clinical decisions and increases the chances of repeat visits, unneeded care, and even readmission, all of which decrease the chances of providers getting paid for the treatment they delivered.

Take long term care, for example. While long term care patients do have acute episodes, 95% of their time is spent outside of an acute care facility's walls. As a result, acute care facilities typically have only 5% of a patient's full EHR. If this is indeed the case, how are acute care providers expected to provide the best care possible if they don't have full access to a patient's EHR?

The period when a patient transitions to a different care setting is critical to being successful in a fee-for-value model. This is where all care team members must be on the same page with the same information to avoid repetitive clinical decisions from being made when a patient makes the transition. With a longitudinal EHR, a general practitioner can quickly review a patient's hospital visit to determine what tests were run and their results. This enables the provider to avoid overlapping tests, the implementation of incorrect therapies, and medication prescription errors. A longitudinal EHR presents the opportunity for all providers across different facilities to make better informed clinical decisions for enhanced care coordination, boosting the quality of care and driving profitability.

In addition, a longitudinal EHR can go beyond traditional health care settings. For example, the technology is capable of providing information about patients receiving care from an in-home provider or who are at home recovering from surgery. When patients leave a health care setting, providers typically do not have insight into their well-being until they return for a follow-up appointment. If in-home caregivers, family members, patients, and providers were able to access a longitudinal EHR, the entire virtual care team would gain access to valuable data.

For example, patients discharged from the hospital following hip surgery must follow a set of care instructions to enhance their recovery. Instructions may recommend the amount of steps needed to be taken each day to increase mobility.

Typically, providers are in the dark about whether patients are following the regimen. In some cases, they even may be unaware that a patient suffered complications and needed to return to the hospital. In a longitudinal EHR, in-home caregivers, family members, and patients themselves can log data, including symptoms. As a result, providers can monitor patient progress directly from the EHR. This provides them with valuable information before a follow-up visit, and helps to prevent potential setbacks and avoid rehospitalizations.

Ultimately, a longitudinal EHR brings care coordination to the next level by giving providers access to patient behavior away from the organization. It also allows providers to monitor patients remotely, a benefit that can lead to better outcomes both in terms of care and costs.

The Next Generation of EHRs
In a fee-for-value payment model, maintaining connections with patients away from the primary care setting is key to ensuring providers have access to the most current and complete data. Empowering providers with the right information and putting all stakeholders on the same page enhances the clinical decision-making process and improves overall care coordination.

A longitudinal EHR bridges the communication gap between providers and connects everyone involved in the care process to allow all parties to make informed decisions.

Although a longitudinal EHR may seem like a pipe dream, the technology is not too far from becoming a reality. In that regard, the health care industry is on the brink of an EHR revolution, one that aims to foster a higher standard of care through greater collaboration while giving health care organizations the opportunity to remain financially viable in a fee-for-value system.

— John Damgaard is CEO and president of MatrixCare.