Leveraging data with physicians to drive value-based patient care

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As the underpinnings of value-based patient care transform the clinical, operational and financial strategies of hospitals and health systems across the country, the foundational structure of the transaction-based traditional fee-for-service (FFS) reimbursement methodology may no longer align effectively with the needs of patients and providers. Whereas providers’ reimbursement has been traditionally unbundled with separate payments for every test, procedure or consultative visit, healthcare is moving towards an approach where reimbursement also reflects the quality and outcomes of care longitudinally over time. This shift poses many operational and organisational hurdles for healthcare providers, who will need to unify the somewhat disjointed needs and perspectives of clinicians, health systems and patients while realigning funding models to reward the required behaviour changes from all participants. To effectively shift to value-based care, healthcare provider organisations will need to develop a collaborative approach with physicians to measure, identify and reduce quality and cost variation, build trust, drive efficient processes and deliver results. This will not be possible if the important clinical, financial and operational stakeholders do not have accurate and accessible clinical data from their electronic health record (EHR) and trusted cost data from their cost accounting application for each patient they serve. The success of hospitals and healthcare organisations in value-based care will depend on their ability to leverage data and engage physicians to drive improvements. In this paper, the experience of Yale New Haven Health System supported via a collaboration with Strata Decision Technology provides a roadmap for health systems to significantly improve care and drive better financial outcomes in both value-based care and FFS settings for the patients we serve.