Readers Write: It’s Time to Level Up Value-Based Care by Integrating Real-Time Patient Insights into Workflows

It’s Time to Level Up Value-Based Care by Integrating Real-Time Patient Insights into Workflows
By Rob Cohen

Rob Cohen, MS, MBA is CEO of Bamboo Health of Louisville, KY.

The push for transformation in healthcare is ushering in a new era of care that focuses on delivering better patient outcomes, at better costs, and with better experiences to drive value-based care (VBC). In pursuit of this vision, governing bodies such as the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) are working to implement changes to improve the quality of care nationwide. While this work is a step in the right direction, it has major implications for healthcare providers on the frontlines of care delivery.

For example, CMS has set the expectation that all Medicare beneficiaries must be covered by VBC models by 2030, meaning that the need to meet quality measures will only increase in the coming years. This is concurrently happening when many of the adjustments that afforded health plans some flexibility in CMS Star Ratings measures during the COVID-19 public health emergency (PHE) are about to expire. As such, health plans and provider organizations are seeing a significant impact. Findings released from CMS this October highlighted that the number of Medicare Advantage plans with drug coverage with a Star Rating of four or more in 2023 is down 68% compared to 2022.

To combat these challenges, real-time patient data is one of the most critical tools available that can help improve quality measures in alignment with VBC goals. However, today, patient health data is often disjointed, delayed, and overwhelming for providers to manually sift through. Without patient information seamlessly flowing with patients as they go from one point of care to the next, healthcare professionals often lack an easy way to surface treatment gaps and provide context to the care they previously received. This fragmentation and data overload add friction for healthcare providers, which causes clinical and administrative burdens, and ultimately, leads to missed opportunities to positively impact patient care.

Digital healthcare technology solutions can address this disconnect by shifting the focus from simply sharing as much raw data as possible towards providing health plans and providers with real-time insights directly in their clinical workflows during high-impact moments. In turn, this helps providers ensure patients are receiving the right care interventions, at the right time, for the right outcome.

Accomplishing this requires technology that enables quick, fluid insights shared among providers, and between health plans and providers, to ensure the identification and solving of gaps in patient care. By offering healthcare providers actionable insights within their clinical workflows, they can more easily pinpoint patients who could benefit from follow up and transitions of care support.

This is especially true during high-impact moments in a patient’s care journey such as medication checks care transitions, post-treatment follow-ups and screenings, where complete insights can make timely follow-up care and achieving associated quality measures more attainable. During these critical moments, enhanced care collaboration efforts and improved real-time intelligence sharing help to bring care gaps to light, as well as support quality measures that have been built into VBC models such as CMS Star Ratings and HEDIS measures.

From there, providers can make informed care decisions and implement corresponding workflows for timely, effective post-discharge transitions and follow-up treatment to increase member engagement. Furthermore, the increased adoption of and adherence to evidence-based guidelines and technologies for care gap closure can help healthcare organizations lessen information barriers and misaligned workflows between providers and health plans to increase revenue and alleviate clinical and administrative burdens. 

As we look to the future of healthcare IT, technologies that identify and solve care gaps will position providers for the most success. By helping health plans and clinicians more effectively collaborate and engage patients during the high-impact moments that matter, these technologies can enable more-informed care. In turn, this improves patient outcomes, lowers costs and drives the industry towards a greater adoption of VBC.