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Empowering Value-Based Technologies with Standardization, Agreement, and Leadership
By David Fryefield, MD
Community-based oncology practices, like other healthcare organizations, are struggling to understand value-based care, how to deliver it, and what resources they need to be successful in this increasingly complex and evolving landscape.
When discussing value-based care, talk quickly turns to the need for cutting-edge technologies to track and measure the quality of services provided. In a value-based world, value is defined as the ratio of quality over cost, and the focus is on measuring quality. In our volume-based world, quality was always there, but we did not necessarily measure it, since it wasn’t a requirement in the reimbursement system. Now, however, measuring quality is critical, and that is where technology can play a vital role.
Many organizations are moving forward with technology solutions to help measure quality in this new value-based environment. However, it is important to realize there is much work to do before deploying these technologies, as technology alone is not going to be the catch-all solution.
Several things must happen to enable the technology solution to be an effective tool, and it all starts with standardization of care processes and consensus within the practice. First, quality must be defined; determining what the critical components of quality care are and what will be measured and analyzed. Then there must be agreement within the practice on the components of the care delivery process and how each step will be performed, as this enables the ability to measure whether or not steps and tasks were completed as defined. If the goal is to measure a component of care delivery and every physician does it differently, the end result is immeasurable. So, unlike the fee-for-service world, the value-based environment requires standardization. This is a critical first step, and possibly the hardest, on the road to quality and must occur before technology can effectively be used to measure the various quality components.
Once consensus and standardization have been achieved, technology can be utilized to determine the quality over cost ratio, or the value definition, which can drive both cost and quality improvements. Each step of the care delivery process can be measured and analyzed to identify opportunities for reducing costs while improving or maintaining quality.
For example, a growing concern is the number of oncology patients who visit the ER or are admitted to the hospital. Many of these patient trips to the ER are unnecessary, creating a drain on the healthcare system financially. By being proactive in patient care, this number can be reduced. Technology can track how often it is happening and then predictive analytics can identify risk factors that, if measured ahead of time, can allow clinicians to help patients avoid a trip to the ER or hospital.
End-of-life care is another area where predictive analytics can support better care and help lower costs. Ensuring patients understand treatment options and giving them a voice in their care decisions are important factors in the perceived value of care. If oncology practices have a system in place to measure variables that can predict when a patient could benefit from end-of-life counseling, a better patient experience could be provided.
What is required from a technology standpoint to get where we need to go? First, changes must be made to EHRs. Accurate, comprehensive data needs to be captured in the EHR so it can be easily accessed, shared across the care continuum, extracted, and analyzed. Several technologies come into play here, including EHR and interoperability platforms, as well as data analytics. Once analyzed, the data needs to be presented back to clinicians and others in the practice in a simple format, such as user-friendly dashboards, providing actionable insight for fact-based decisions. Additionally, real-time data will play a crucial role in value-based care. To provide proactive care, information must be timely, ongoing, and constantly monitored – key areas in which technology solutions will be invaluable.
Leadership will also be required to help the organization evolve. Practice leadership is an important part of the equation, guiding the consensus and standardization needed to achieve measurable results to support quality care and lower costs. Technology by itself will not yield much progress on the journey to value-based care. The transition requires the full package ― advanced technologies and leadership ― to drive development of the framework needed to empower the technology solution. The practice workflow and culture that the technology is deployed in is really the critical issue. A practice can have the most advanced technology available, but if a plan has not been developed and agreed upon on how to effectively deploy it, and leadership is not in place to drive the plan, a great deal of the technology solution’s power and potential is lost.
David Fryefield, MD is medical director of operational excellence for The US Oncology Network, and practice president and radiation oncologist with the Willamette Valley Cancer Institute and Research Center.