As Medicare and a growing number of private payers switch to value-based payment systems, healthcare facilities face the ongoing challenge of determining how to transition from the traditional fee-for-service models while preserving their bottom lines. While value-based payment systems are often complex and come in various forms, technology is a critical component of helping make these systems successful for healthcare facilities.

“A thriving value-based payment model requires accurate, meaningful and actionable data in real time on both the quality and costs of care,” says Todd Devree, director of Bundled Payment Solutions at HealthTrust. “Plus, the data needs to be linked so you can see the real value that was delivered to the patient or groups of patients.”

Manually accumulating and aggregating data is time-consuming, costly, not scalable and less effective than using technology. “Providers need massive amounts of data from a variety of sources disseminated in a way that will be meaningful to their practice, Devree continues. “That level of scalability and flexibility requires a technology strategy,” he says.

With the ability to access national data and measure it against a particular facility’s data, the right technology strategy allows hospitals to quickly see how they stack up against benchmarks, and where and why they are performing well or poorly compared to standards.

“We can easily see whether a hospital will be eligible for reconciliation payments, quality incentive payments and effective discounts, and predict the estimated reconciliation payment if targets are met,” says Cheryl Lovett, consulting business analyst in HealthTrust’s Technology Innovation, Membership/Clinical Program. HealthTrust can also highlight specific areas that have the greatest impact on cost and quality, such as implant costs, complication rates, specific quality measures, extended length of stay and choice of post-acute care facility.

With a clear understanding of where a hospital stands in terms of cost and quality and the significant areas that have the greatest impact on both, HealthTrust can help identify specific actionable steps it can take to improve quality scores and reduce costs—quantified in terms of points and financial impact.

Improving the Patient Experience

improving the patient experienceTechnology solutions allow hospitals to address various aspects of healthcare improvement, including the patient experience. Consider a patient set to undergo hip surgery. A widely accepted practice for educating and preparing patients for the surgery is to give them a folder full of pamphlets with information targeted to certain procedures. Another common practice is to urge the patient to attend a class before their particular surgery.

“While pamphlets and joint classes can be effective, they’re not patient-specific,” Devree says. “Education designed to prepare patients and properly set expectations is most effective when it’s targeted to a patient. And with technology, we’re able to do that.”

For instance, digital education programs can be tailored to specific patients by age, activity levels, diagnosis and procedure, and can be delivered to the patient online or by email.

Technology also allows providers to efficiently communicate the information patients need at relevant times in the process of care. “Pamphlets and joint classes give patients all the information they need all at one time, and they’re expected to remember it several days, even weeks, later,” Devree says. “A technology platform can deliver the right information at the right time—without disrupting the provider workflows. With technology, providers are able to deliver patient- and procedure-specific information more often. In return, patients are better prepared, leading to an improved overall experience and higher satisfaction.”

In addition to using technology to communicate directly with patients, providers and facilities can also use technology to collect and store patient data over time in order to provide better, more informed care to each patient. “Technology allows us to collect baseline functional status as reported by the patient prior to surgery,” Lovett says. “This provides a measure of comparison when collecting patient-reported outcomes at various intervals following the procedure. We can also collect patient-reported data about their functional status and quality of life at various intervals over time following surgical procedures, which allows us to identify and react to negative responses.”

Technology solutions for improved patient care also include online tools for clinical staff that are proven to increase the quality of care, as well as provide care coordination and continuous engagement among all providers after a patient leaves the hospital. With technology, it’s also easy to “follow up with patients at set intervals after discharge from the hospital to ensure they are recovering well, and identify issues at the first opportunity, thus avoiding readmissions and other complications,” Lovett adds.

HealthTrust Technology Platforms

  • Streamline the capture and reporting of patient-reported outcome measures (PROM).
  • Link quality and cost data so providers can better understand the value of the care they are delivering.
  • Engage and educate patients throughout the episode of care with patient- and procedure-specific content delivered at relevant times.
  • Capture and report data that can be utilized in care design.
  • Establish patient- and procedure-specific protocols that lower the risk of readmissions and complications.
  • Identify internal cost reduction opportunities to preserve and grow margins.

This story first appeared in the Q3 2016 issue of The Source magazine.

Boosting Population Health

Advances in technology have made it possible to accumulate massive amounts of data and disseminate it in a meaningful way, allowing for more accurate, timely and cost-effective delivery of care, Devree says. “Advancements in technology allow for earlier detection of diseases, and predictive modeling enables prevention rather than treatment,” he adds. “As a result, patients will be treated sooner and populations will be healthier. The additional benefit of care prevention is an overall reduction in per patient costs.”

Technology solutions also provide a standardized method of collecting clinical, cost, quality and outcomes data from various sources. This data can be “normalized” to account for differences in patient populations and geographic locations, compared to national averages, and brought together in a comprehensive manner so it can be studied, trended, measured and analyzed, Lovett adds.

Reducing Healthcare Costs

Finally, technology is a powerful tool for reducing the per capita cost of healthcare. The data generated can help a facility understand all the costs incurred during each component of a patient’s entire episode of care. Data gathering can also be structured to compare the actual costs to the target costs set by the Centers for Medicare & Medicaid Services (CMS) and to national averages for the same procedure performed on a similar patient in the same geographic region.

“Detailed analytics allow us to drill down from the total cost of the episode to the cost of each segment of the episode, and further, to each cost-contributing factor within each segment of the episode,” Lovett says.

Lovett gives the example of an inpatient stay for a knee replacement surgery. If a facility’s total cost for that surgery is trending higher than the national average or averages at other facilities, technology makes it easy to dig deeper and discover underlying factors. Those factors might include an average length of stay that is a half-day longer than the national average, or a higher average cost for implants than the average cost of similar implants used at other facilities. The ability to drill down to details for a given facility allows decision-makers to identify the factors that have the most significant impact on cost. With that knowledge, facilities can work to implement strategies that will reduce costs while maintaining a focus on quality.

In 2014, Medicare beneficiaries received more than 400,000 hip and knee replacements at a cost of about $7 billion, and there is a large variation in the costs and outcomes of these surgeries, according to Devree.

“Utilizing a technology platform, we’re able to capture and link the quality, cost and provider data to identify outliers and opportunities for improvement,” he says. “The data will tell us the whole story and help guide future decision-making.” For instance, medical devices can make up 30 to 40 percent of a total inpatient reimbursement, so facilities must determine whether those devices are providing 30 to 40 percent of the value.

“With technology, we’re able to link the cost of implant components to outcomes so providers have the whole story and are able to make the right decision for the patient,” Devree adds. “You never want to sacrifice quality for a lower cost, but if you can provide an equivalent outcome for half the cost, you can greatly reduce the per capita cost of healthcare.”

HealthTrust members have access to technology platforms (see below) that can help them thrive in value-based payment models. Michael Schlosser, M.D., chief medical officer of HealthTrust, and his team can provide members with an assessment to determine which technology is appropriate for each member’s unique situation.

As HealthTrust collects and analyzes clinical, cost and outcomes data from each of its members, it will be better able to spot areas of weakness and define strategic initiatives members can consider to improve quality and reduce costs.

“In tandem, however, we are doing something even greater,” Lovett says. “We are developing a comprehensive collection of data that can be researched, measured, studied and analyzed. Through these activities, a knowledge base will evolve, filled with evidence-based best practices that can be applied across our membership.”

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