Do physicians have the right tools to deliver value-based care?

Analytics are rapidly changing how physicians and health systems approach patient care. Data is also increasingly used to create a more open dialogue between providers and patients. At the same time that healthcare is becoming more data- and technology-driven, the way providers are compensated for the care they deliver is changing. Increasingly reimbursement is tied to “value” –the quality of care providers deliver, not on the type or quantity of services they provide.  

Related: CMS adds flexibility to its revised Medicare reimbursement program

The question is: Do physicians have the right tools to deliver value-based care?  

A recent study suggests the answer is no. Commissioned by Quest Diagnostics and Inovalon, Finding a Faster Path to Value-Based Care shows that the complexity of managing multiple quality scoring systems, risk adjustment models, reimbursement rules, incentives and penalties related to value-based care is far more challenging for physicians than may be generally acknowledged. It’s also clear that new tools are needed and wanted to overcome these obstacles.

The survey found that fewer than half of all respondents (47%) agreed that it’s clear to physicians which quality measures apply to their individual patients under value-based care models. Seventy-nine percent of the physicians surveyed said they do not know the quality metrics that apply to individual patients that would allow their practice to qualify for financial incentives under value-based care models.

More Health Law news: Does insurer drop out in South Carolina risk health of individual exchange?

Value-based care models require physicians to have this information at the point of care so they can align care with quality, outcomes and other measures on which financial incentives are based. Imagine how much financial leakage occurs that could be stemmed if physicians had ready access to this information so as to align care with quality measures during the patient consult.

Next: The key to value-based care adoption

Of course, some patient information, such as medical history, can and does come from electronic health records (EHRs). But today’s EHRs do not contain the information necessary to meet multiple and highly complex quality requirements specific to each patient. Perhaps this explains why an overwhelming majority (85%) of physicians surveyed said they were likely or very likely to use a tool that provides on-demand, patient-specific data to identify gaps in quality, risk and utilization. Moreover, they would like to have access to this tool within the clinical workflow in real time.

Further reading: 3 steps to get ready for MACRA

New technologies, particularly in analytics, are emerging that may help address these gaps. But the key is making sure physicians are aware of the solutions available to them. Nearly half of respondents in the survey either don’t believe a tool that can help them align gaps in quality, risk and utilization in real-time exists or aren’t sure.

This points to another key finding from the survey: 44% of health plan executives said physicians have access to such tools, but only 29% of physicians said they did. Clearly, health plan executives may not recognize the challenges physicians face in accessing technologies that will help them align care with value-based metrics. 

More Health Law news: Concierge medicine becomes an option in reform era

The study clearly shows that the key to value-based care adoption is not more data. It is technologies that help physicians make sense of, and take actions based on data. This is what physicians should now be demanding – tools that make it easier for them to access the right information to align with the requirements of value-based care. This new model of healthcare depends on how efficiently and effectively physicians can access the information they need where and when it’s needed most.