Health IT models must align incentives

April 1, 2014

Value-based designs aren’t just nice add-ons, but rather they represent new business propositions

Health IT is going through an era of both expansion and convergence, in which the universe of available information is growing exponentially, while at the same time, we’re trying to smash all the resulting data together into dense little packages. It’s kind of like the big-bang theory meets big data.

We’re filling up our EHRs with information and adding all of that to our claims data. But what are we going to do with it now?

Regardless of how we choose to take advantage of today’s cosmos of health information, our strategies must ultimately lead to greater affordability, quality and satisfaction. Gather all the data you want and churn it through your big data machine all day long, but if you don’t turn it into value, it’s a wasted effort.

Alignment is the bigger issue

Brett Davis, a Consulting Principal at Deloitte, tells me that in just the past few years, technology has opened up health plans’ possibilities to turn information into value. Data sharing is improving, and cloud-based applications make real-world collaboration feasible and affordable.

At last, analytics have made enough progress that payers can even begin to tap into unstructured data, Davis says. Deeper exploration into providers’ clinical records will help payers enrich their own databases and vice versa.

So here is all this data, scattered throughout the industry, and mostly what we're focused on is struggling to gather it up. What a daunting task. In an online poll in late February, Deloitte found that more than half of stakeholders believe aggregating data from disparate health IT systems is the biggest barrier to adoption of analytics capabilities. Sure that's a serious concern, but it's more short-term, relatively speaking.

Davis says, even though interoperability still has a ways to go, the even bigger issue is taking data to the next level by creating business models to support long-term, sustainable exchange of information among stakeholders. And the interface is not just swapping data for the sake data, but rather for the goal of achieving value.

NEXT: What you really want >>

 

Sustainable models

Pharmaceutical companies, for example, increasingly want access to information on population needs to create best-value products. Payers need access to treatment outcomes to determine best-value benefit design. And providers need access to historic patient data to create the best care plans.

“Yes, information exchanges have made progress, but you must find a sustainable business model of incentives where you have an industry that needs to show relative effectiveness. And to be able to do that, you need new collaborative models,” Davis says.

The synthesis of data will translate information into value-based business models. Insight, rather than raw data, is what will make the most impact.

The business case

Value-based designs aren’t just nice add-ons to what the industry has already built, but rather, they represent new business propositions. Every stakeholder should be involved in some model of shared savings already or should be seriously considering one in the near future.

“No issue today is looked at in healthcare without cost being the overarching theme,” Davis says. “This is where it’s important to start understanding and identifying what subpopulations are going to have maximum efficacy and to look at overall costs.”

According to Davis, the key questions to answer in the next year are: what’s working, for whom, why and at what cost? Each stakeholder has a piece of the data needed to discover the answers.

Payers are evolving away from the status quo and putting theoretical ideas into practice. But as we take advantage of the technology that’s available, we must also design the value-based models to support it.