MercyOne

Derek Novak

As US healthcare continues its journey towards “value based care” and more explicitly, a transition to provider organizations assuming risk, a core element for success often remains absent—data. One of the most fundamental components required for success under value-based care is an overlay of a robust data analytics and to accomplish this, one simply must have access to such information.

So what accounts for this absence in an industry perceived to be rich with data and information? Generally, it can be attributed to a reactive and fragmented approach of healthcare organizations and their adoption of electronic medical records(EMR) and other operational systems housing this vital information. Electronic medical records, billing, and purchasing systems, were generally implemented to serve a sole regulatory requirement deadline, or an individual department’s process need. Often it was done without a future vision of the data’s use or an (unrealistic) panacea promised by a given system vendor.

This is a notable barrier when not only is there data fragmentation within a given health system, but the problem/fragmentation/barrier is also? magnified when healthcare organizations look to collaborate for value-based care and to assume risk. Experience has shown that within a single health system, there may be an adoption of greater than fifteen electronic health records or registries. All to be successful in the assumption of risk under value-based care, this disparate data is a critical element of success, and these systems provide a barrier to care coordination for at risk members.

In turn, many ACOs (Accountable Care Organizations) are faced with the barrier of how to operationalize a data analytics strategy. As health care organizations are saddled with the unlikely decision to abandon years’ worth of work and costly EMR implementations that do not provide interoperability, or explore a generally unknown path of an agnostic data/ information aggregation approach.

While the latter is perceived as the most difficult and provides the greatest level of uncertainty, primarily due to historic varying levels of success with HIEs (Health Information Exchanges), the question should be why? Is the aggregation of data and information really that difficult? Or merely is it access to the information? Given advancements in other industries such as social media platforms, or let alone “smart-speakers,” linking disparate sources of data and information through a single sign-on-like approach is nearly common place. The fallacy of a single system being superior is rampant within healthcare and possibly points to the easiest path, but necessarily not the most cost-effective nor achievable in the space of ACOs.

Today many provider collaboratives, including ACOs, are exploring this agnostic approach to data. They are engaging typical vendors to develop solutions to healthcare’s disparate data problem and many with notable success. These partnerships are delivering increased insights to health system operational opportunities to drive things like member loyalty as well as opportunities to drive down the total cost of care. Ultimately, this leads to improved care for members as well as significant financial return when a value based care arrangement is in place.

Unfortunately, until regulations push for further standardization of data and requirements on the sharing of data and information, what’s described above will be a necessary exercise. At least for those that have the desire to come together to redesign US healthcare delivery. So as you consider the landscape of US healthcare and the decision to assume risk, which path will you explore?