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Implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has already begun, and organization need to step up their planning to be sure they are prepared. A key component of a successful MACRA implementation is the technology behind the transformation. Planning for IT-enablement is vital to positioning any healthcare organization for success in this value-based payment world. 

Healthcare organizations today operate in an environment with multiple disparate data sources, including heterogeneous electronic health records (EHRs). To effectively manage population health through Advanced Alternative Payment Models (APMs) -- which are a core component of the MACRA process -- requires technology that can bring this data together to rapidly inform decision-making, measure performance and outcomes, enable data liquidity, and operate in a heterogeneous environment of data sources.

 To create that environment, organizations need to establish an IT infrastructure roadmap focused around three fundamental capabilities – care management, patient engagement, and analytics and measurement.  To ensure data flows as unencumbered as possible, health information exchange (HIE) capabilities must also be leveraged.  As a health system defines its roadmap, it should consider EHR-agnostic approaches to ensure all stakeholders engaged in coordinating care, including patients and providers, can “sing from the same hymnal” and have appropriate access to complete longitudinal patient information.  

Four things a Value-based Care IT roadmap should include:

  1. Single Patient Portal. A patient portal acts as a point of contact for patients to engage with all of their providers. Through this platform, they should be able to ask questions, receive educational material, schedule appointments, request prescription refills, access test results, and pay bills.

    In today’s environment if a patient has more than one physician and has visited a hospital they are likely to have multiple patient portals – regardless of whether their providers are all in the same network. Patient portals are tethered to the underlying EHR. This is not a sustainable solution.  To effectively build IT-enabled patient engagement patients will need a single portal that pulls together all of their longitudinal information.  At this point the technical challenges are significant, but this is particularly important to Advanced APMs with the emphasis on patient engagement.  Some vendors are now describing this capability on their development roadmaps; healthcare organizations should be aware of this in ongoing discussions with their vendor partners. 

  2. Care Management: Critical to the success in at-risk contracts -- whether through government or commercial programs -- is the ability to coordinate care for high risk/high utilizing patients, and provide all patients with access to screenings and immunizations to promote wellness. These activities rely on data collected through EHRs in multiple settings, as well as data from retail pharmacies and other settings to “paint” the full picture of a patient’s care, and where their might be gaps. Care coordinators can use this data within the care management process to ensure patients are receiving the care they need, and to identify interventions, such as a ride to the pharmacy, or a home visit, that would improve their condition or prevent it from deteriorating to the point that more intensive clinical intervention is needed. 

    The IT plan should include definitions of the various care management use cases that can then be tested against existing capabilities or used as part of an application selection process.  In addition, a data integration plan must be defined, implemented, and continuously monitored since changes in the source systems can affect the data flowing to the care management application.  These are typically time-consuming critical path items, and healthcare organizations should be sure they set aside ample time and talent to address these issues. 

  3. Data and Analytics. Reporting is not analytics. Most organizations are awash in thousands of reports – many of which are run once and never looked at again.  Health systems need the ability to aggregate reliable data from across the health system to support measurement and analysis of populations.  While EHRs provide robust operational reports to manage day-to-day activities and external metric reporting, understanding overall organizational performance, risk profiles of specific populations, and trending results over time requires analytic capabilities over and above static reports. 
  4. Health Information Exchange (HIE). Health systems will need to operate in a heterogeneous environment of data sources. Period. Consequently, organizations must invest in and implement HIE technology and related processes that support data liquidity among the various stakeholders including providers, pharmacies and labs; and can provide measurement and analytics of that data.

To ensure the information needs of the organization are being met with respect to value-based care, an inventory of all existing technology should be conducted.  The capabilities represented by this inventory should then be compared to the goals and objectives of the organization, and redundancies and gaps should be identified.  That information can be used to establish remediation plans for the gaps and redundancies – or to justify their existence.  In addition, data from various applications should be evaluated for accuracy and completeness.  Often organizations discover that data which is “supposed” to be the same is sourced from different places and is conflicting. To support the above technology considerations, process and people skills are required to take advantage of the acquired technology, implement the new processes, and interpret the information created. 

Stay tuned for our next post where we will dive into the related processes and people skills that enable
the right data are provided to the various stakeholders at the right time to support the required functions.