Five Essentials Missing from EHRs for Successful Value-Based Care

The EHR market is maturing, but value-based care needs are not being met, according to a new survey.

The survey, from Sage Growth Partners, found that 70% of providers have had an EHR for at least three years, and 65% are unlikely to replace them in the next three years. However, less than 25% believe their EHRs can deliver on core KLAS criteria for value-based care.

“That’s striking, considering how important value-based care is and will continue to be to the industry,” says Dan D’Orazio, CEO, Sage Growth Partners.

Sixty-four percent of healthcare executives say EHRs have failed to deliver better population health management tools, and a large majority of providers are seeking third-party solutions outside their EHR for value-based care.

Sage Growth Partners conducted an online survey of 100 healthcare executives (87% C-suite) to understand their perspectives about what EHRs can, and can’t, do well to give them what they need in today’s environment. In-depth interviews with six healthcare executives augmented the survey.

“We were heartened to find that over two-thirds of respondents say they are realizing a return on their investments into value-based care. Unfortunately, most of them said they can’t get the capabilities they need from their EHR, so they’re building or buying additional solutions to get, analyze, and use their data to improve health,” says D’Orazio.

“Healthcare providers face tremendous challenges when they try to gain a holistic understanding of their populations and intervene to improve their health,” says Niki Buchanan, business leader, Philips Wellcentive, a provider of population health management software solutions. “Limited data interoperability and visibility into the patients who aren’t coming in for care are major roadblocks. This survey confirms what we hear in the market, which is that most executives are not getting core functionalities such as care coordination, risk stratification, and patient engagement. As they take on more risk, they’ll need those capabilities to remain viable.”

It’s significant that respondents identified a gap between the key proficiencies they need for value-based care and their current satisfaction levels with these capabilities, according to the survey. Quality reporting was the only area where most executives (70%) are satisfied with their existing capabilities. Less than half of respondents are currently satisfied with their abilities in these key value-based care areas: patient engagement, data aggregation, risk stratification, population health analytics, and integration of clinical and financial data.

The report findings are very much in line with the technology challenges Charles Saunders, MD, CEO of Integra Connect, a provider of technologies and services for value-based specialty care, observes practices grappling with as they attempt to transition successfully to value-based care models.

Saunders

“EHRs were a foundational technology of the fee-for-service era. They focused on automating the documentation around in-office patient encounters and subsequently converting those visits to appropriate billing codes,” says Saunders. “Now, however, payers entering value-based care agreements with practices increasingly hold them accountable for the quality and cost-efficiency of the care they deliver, typically across comorbidities and care settings. Managing patients holistically requires these practices to transform their operations, clinically and financially. As a result, not only do EHRs themselves need to evolve to reflect these new requirements, but practices must embrace an array of new technologies, services and skills with the goal of managing their populations holistically. That’s the source of the disconnect that the report findings so accurately identified.”

The EHR can no longer be the primary focal point of practice technology, according to Saunders. “It remains an important data input, but one among many- including claims, prescriptions, labs, hospital ADT feeds, and more-that support true population health management, coupled with rich analytics and the tools to directly impact quality and cost,” he says.

By contrast, Saunders sees many EHR vendors using messaging that implies they are indeed ‘the’ solution to support practices’ value-based care needs. “However, when you dig deeper, they are typically referring to ability to capture specific data points in their EHRs and then report that out for MIPS or existing Alternative Payment Model (APM) programs. It’s confusing many practices and this was evident in the report findings as well.”

Next: Healthcare execs well-positioned

Important for healthcare execs

According to Saunders, payers seeking cost and quality improvements in their populations need network providers to be appropriately equipped to manage patients more holistically-which requires a much broader foundation than an EHR alone can provide. 

“The good news is that population health management is a core competency of the payer world and executives are well-positioned to collaborate with key providers to help them identify and adopt new skills, technologies, and competencies,” Saunders says. “Managed care execs also bring crucial data to the table, most notably claims, as well as an understanding of proven interventions such as care management that the practices must now adopt.”    

Based on the study, D’Orazio has three tips for healthcare executives:

• Don’t wait for your EHR to provide certain tools. 76% of those surveyed in the report said that they have realized a return on investment from value-based care, and almost half of those respondents (46%) say a third-party population health management solution was critical for success. “Look to other partners to start building the basic functionalities you need for value-based care now,” D’Orazio says. “EHRs will likely catch up, but if you wait for that day to come, you’re going to be behind.”

•  VBC is here to stay and the cost of inaction is steep. Healthcare executives should create a value-based care roadmap and align their technology toolkit accordingly, D’Orazio says.

•  Identify technology partners that can deliver the most business value in any area, and assemble an ecosystem that works for your organization’s goal. Survey respondents expressed frustration with EHRs’ inability to address interoperability, social determinants of health, patient engagement, and aggregating and using data from disparate sources.

According to Saunders, there are five components that are missing from traditional EHRs that are needed for value-based care success:

• Failure to capture needed data to support robust quality reporting. “That’s because appropriate fields don’t exist, or they exist but do not capture data in a required or structured format,” Saunders says. “Take, for example, a field that captures unstructured information about a diagnosis and may be left blank, or misspelled, or described differently by different clinicians. We are often called in to support clients with manual chart abstraction to ensure that they are able to generate consistent, reliable data across individual EHR records.”

• Lack of interoperability, including integration with other EHRs, care management applications, hospital feeds, pharmacies, and more. This is not only an issue of getting vendors to cooperate, or building custom interfaces once they do, but finding somewhere for data to go, as the EHR was not contemplated for that use, according to Saunders.

• Lack of claims-based payment history, which is essential for providing a holistic, longitudinal view of individual patient care history.

• Analytics. “The challenge I mentioned earlier with reliable data capture also manifests itself in the ability to report out for quality measures,” Saunders says. “Again, however, it’s important to remember that the analytics that reside in an EHR are a ‘point solution’ and will not provide the breadth of data, insight, with the real-time availability and predictive capabilities, to actively manage cost and quality at a population level. 

• Team-based care management and decision support work flows, including care pathway integration at the point of care. “Fee-for-value work flows are more complex than traditional EHRs support,” Saunders says. “While the office setting remains important, value-based requires a cohesive, evidence-based and guideline-driven work flow that engages all members of a care team, no matter what the setting-and even into the patient’s home.”