Value-Based Care: Towards Better Outcomes and Lower Spending
Health systems are under increasing pressure to improve their patient’s experiences and outcomes while simultaneously working to rein in costs. Several factors are at play including new regulations and payer programs (e.g. Bundled Payments, MACRA/MIPS, Blue Quality Physician program) with providers and clinicians increasingly focusing on relevant quality scores to help them achieve their revenue projections.
National initiatives, standards, and programs are being established to guide and measure provision of care according to standard pathways and clinical practice guidelines derived from clinical evidence. However, less than 15% of clinical practice guidelines are actually supported by high quality evidence. This shocking statistic underpins the need for strategies to collect standardized healthcare data across settings to inform the measurement and accurate reimbursement models
Incentivizing a reliable way of measuring clinical quality and overall cost of patient care will lead to transparency and to value-based competition, for instance, being able to make statements like “best kidney transplant program in the US”. The introduction of clinical registries brought clear value and return through optimizing clinical practice, for example, shaping complex treatment protocols in cancer (such as acute lymphoblastic leukemia or proving the interrelationship between smoking and treatment efficacy for rheumatoid arthritis. Publicity on outcome measures puts pressure on individual hospitals, potentially impacting their reputation and reimbursement.
Health plans and health systems are facing an increasing reporting burden for both cost and quality data, both internally and to external stakeholders. The workload to extract the necessary data for calculating, reporting and analyzing measure scores is not negligible due to the complexity of historically-grown IT systems and processes in the healthcare sector resulting in a high administrative burden, delays and billions of dollars spent per year.
The paradigm shift towards value-based care, i.e. maximizing patient outcomes over cost, is not just adding a new variable – value – to the equation, but it relates quality of care to the end-to-end cost of the delivery in a case centric manner. Bringing value-based care to life requires:
- A solid understanding of the relationship between invested efforts and the overall patient centric outcomes.
- Integrating best practices-based decision support into the clinical workflows.
- Keeping the knowledge up-to-date and adaptable to specific clinical settings and highly individual patient requirements.
- Keeping pace with innovation and cost pressure by enabling agile and scalable feedback loops across all stakeholders including clinicians, management, payers and professional societies.
Through our work with multiple healthcare provider organizations we have asked clinical managers how clinicians know which clinical measures and guidelines apply to them. The answer that we received reflects the overall situation: “They just ought to know”. From the vantage point of the front-line clinician, this statement clearly shows the gap between [the missing] digital enablement and the depth and breadth of knowledge required to deliver high quality treatment.
With SAP Health for Clinical Quality we have started to address these challenges. The solution prototype enables clinicians and management to launch dashboards for the evaluation of electronic clinical quality measures, integrating all required clinical data and provides “smart” guidelines and guidance that apply to a particular case or patient while making the information tailored and relevant to clinicians working in different care settings across the enterprise. The idea fueling this development is that physicians can focus on providing best-in-class care for their patients while ensuring they meet their objectives for their pay-for-performance and reporting programs by offloading the mental overhead of tracking and calculating patient guidelines on the fly from data they read in the patient’s chart. Tight integration into the clinical workflows, allows going beyond merely providing dashboards and enables integrated quality management at the core of the operations by engaging clinicians at the proper point in time. SAP Health for Clinical Quality aims at closing the feedback loop between quality administrators, clinicians, and patients by providing treatment recommendations and relevant data on measure performance within the critical window of opportunity when actions can be taken to make a difference for the patient, improving both the outcomes and the relevant measure scores.
SAP Health for Clinical Quality as an innovative solution offers a great leap ahead compared to unidirectional reporting schemes or dashboards. In its first version, this solution differs from current approaches to measuring and reporting clinical quality by:
- Providing actionable metrics incorporated into clinical workflows
- Enabling real-time feedback loops through visualizing quality metrics at all levels of the organization and facilitating conversations between managers and clinicians
- Adapting to changing requirements by flexibly ingesting new or updated electronic quality measures
Transparency into clinical quality will enable cost savings. An increase in quality, will also lead to higher reputation and financial stability due to an increase in scores for publicly reported quality metrics as well as pay for value contracts.
The journey does not end at this stage: As in other industries, content access and distribution are just as important parts of the overall offering as the tools to manage or consume the content. However, simplifying the entire process and integrating quality measurement into the point of care as a first step will close the quality feedback loop and have direct impact where it matters most: better care for patients with better outcomes.
If you missed us at HIMSS18, stay tuned for more news to learn more about the SAP Health Clinical Quality solution or contact us to find out how you can be part of our journey into the future.
Contributors: Peter Adorjan & Harrison Fox