Getting Ahead of the ACA's Pay-For-Outcomes Mandate
By: Patrick Jordan, MBA, MA | June 10, 2014
In the United States, the Affordable Care Act is pushing healthcare providers toward a pay-for-outcomes approach that promises to be an enormous challenge for already resources strapped hospitals across the country.
A pay-for-outcomes approach requires hospitals to have mature data management infrastructure and skill sets so they can capture and analyze data about clinical results and use those results to shape the way they deliver care. Going forward, financial incentives will align around data integration, which means providers will need to demonstrate — through hard data — that patients are receiving the right care, in the right environment, and that their quality of life is improved.
But data management isn’t a core skill set for most care providers. They are focused on treating patients, not tracking data streams. And given the fact that 40% of community hospitals today are already running at negative operating margins, it is unlikely that will have the capacity or resources to master these clinical data management requirements in the near term. Nor should they try to.
Just as many biopharma companies have achieved greater efficiencies by outsourcing non-core processes — like recruiting for clinical trials or global commercialization strategies — providers can benefit from partnering with vendors to take on these non-core data management tasks.
By working with vendors who specialize in building data architecture, managing the capture and analysis of critical data, and creating reports that provide hospitals immediate access to relevant data, providers can gain insight into their treatment workflow and outcomes and craft health care delivery strategies to improve them. Such partnerships will help them master the pay-for-outcomes model, deliver better care to patients, and cut waste and overhead from their operations.
Healthcare decision making in the near future will be largely data driven, and hospitals need to build relationships today with industry experts so that they can harness their own data and benefit from an outcomes-based approach to payment in the future.