I recently attended the 3rd Annual Value-Based Care Summit in Boston. I always love visiting Bean Town (baseball, lobster rolls, clam chowder, the Boston Marathon). But I was particularly excited to get into the meaty discussions at the conference. It has been three years since the Medicare Access and CHIP Reauthorization Act (MACRA) went into effect. The law provides incentives for the adoption of value-based payment models for physicians, so I was excited to hear about the experiences health system executives have had so far.
The shift to value-based payment models, it turns out, has been slower than many of us expected, and success stories are limited. While launching pilots and tracking results have been important first steps, full adoption appears to be many years away. We’re likely to see more traction towards these models in 2019, as providers and plans become more aligned to deliver on risk-based payments, according to our national health care leader Steve Burrill. Several speakers acknowledged that the transition was a marathon, not a sprint. But as more non-traditional competitors enter the market, health care stakeholders could pick up their pace.
Case in point: Less than a year has passed since Amazon.com, Inc., Berkshire Hathaway, Inc., and JPMorgan Chase & Company announced they had formed a new organization aimed at reducing health care costs and improving satisfaction among their employees. This venture, along with other technology disrupters, and major mergers and acquisitions within the health care sector, came up frequently during conference sessions and in casual corridor discussions. Many agreed that these disruptions could finally push organizations to pick up their pace and move fully into value-based care.
Many of the attendees—who represented integrated delivery networks, post-acute providers, physician groups, behavioral health providers, and government agencies—were looking for guidance as they prepare to enter the world of value-based care.
Harnessing data from electronic health records (EHRs) could be one way to help physicians improve the value they offer to patients, but few health system executives have made much headway. Emerging technologies such as artificial intelligence (AI), robotic process automation (RPA), and analytics could help harness data from EHRs and unlock their true potential. Adoption of these technologies could help generate deep insights into patients, costs, and quality. While this is a compelling vision, and certainly has the potential to be transformative, few have made it happen yet.
The 2018 Deloitte Survey of US Physicians offers some insight to the issues health care organizations are wrestling with. The EHR findings included in this report highlight several ways that EHRs can be improved to meet physician expectations. This, in turn, can support efforts to combine the data with emerging technologies including AI or RPA. Although physicians are important health care stakeholders, the survey results suggest that many of them perceive themselves as passive participants in EHR optimization efforts. Others simply feel ignored by both health systems (where they are employed or affiliated), and by the EHR vendors. The administrative work associated with EHRs has been linked to burnout among physicians. According to our survey results:
- Sixty-two percent of physicians say EHR interoperability needs to improve, and 58 percent see a need for better documentation.
- Thirty-six percent of respondents said daily documentation-related tasks could be done more efficiently in EHRs.
- Just one-third of physicians said their organization or EHR vendor sought their feedback on EHR enhancements.
The value-based care findings from the Deloitte survey indicate that physicians are ready and interested in bearing financial risk, but they still need supporting tools. Sixty-six percent of physicians said they receive information on their own quality performance, and 67 percent receive data on their own productivity.
But the situation is considerably different for cost-related information. While 72 percent of physicians consider cost data to be valuable (particularly at the point of care), just 28 percent of respondent said they have access to information such as costs for services provided by physicians and facilities to which they refer patients or estimated out-of-pocket costs for their patients. Lack of information can limit a physician’s ability to perform certain tasks. Forty-three percent of respondents said they are not able to find low-cost lab and imaging options for patients, and 36 percent said they cannot identify high-quality skilled nursing facilities, rehab, or home health.
Our survey results support what was on the minds of many people at the summit—supporting physicians can be an important step toward achieving the goals of value-based care, and technology is a key enabler. Some health system executives at the summit said nearly half of their patient revenue was now in in risk-bearing models, while other attendees said they were just getting started in the transition from volume to value. However, the majority agreed that they should be involved in these payment models. Understanding how to harness EHR data and combine it with emerging technologies could help health systems pick up their pace as the industry continues to embrace value-based care.