A White Paper

Seven Key Challenges in the Move to Value-Based Care Ensuring Patient-Centered Care With Information Management

WebFOCUS iWay Software Omni

Table of Contents

1 Introduction

2 Challenge #1: Aligning IT With the Business

3 Challenge #2: Keeping Pace With the Evolving Role of Health Information Management

4 Challenge #3: Enabling Advanced Informatics

5 Challenge #4: Leveraging Data to Support Process and Outcome Improvement

6 Challenge #5: Measuring Physician Performance From New Perspectives

7 Challenge #6: Adopting New Incentive and Reimbursement Models

8 Challenge #7: Dealing With Diverse Data Infrastructures

9 Omni-Patient: Information Management for Healthcare Providers

9 Accelerate Time-to-Value With Nine Pre-Built Business Domains

11 Conclusion

11 About Information Builders

Information Builders1

Introduction

“At the heart of many healthcare industry debates is what to do about data: how to realize its value for quality care, bending the cost curve, how to share it and how to secure it,” says the Institute for Health Technology Transformation.1

Effective use of data is essential in the move to value-based care. However, there’s a lot of data to contend with, and it comes in many formats from many places – clinical and claims systems, HR and financial applications, and third-party sources. In a study by healthcare alliance Premier, 95 percent of healthcare providers say that interoperability challenges limit their capability to transfer data from one medical center to another. This, in turn, slows down the transfer of information about patients, creating potentially dangerous gaps in care.2

Efficient management and exchange of patient and clinical data across the continuum of care – from arrival, admittance, and assessment, through diagnosis, treatment, and follow up – is vital to optimizing clinical decision support, and ultimately, quality of care. Healthcare organizations that struggle with disparate information assets and siloed processes must find a way to make data “fit for purpose” through aggregation, standardization, and enrichment.

Providers need broad-reaching clinical integration among care settings and teams, and across the journeys of individual patients and populations to leverage information to improve cost-efficiency, maintain profitable operations, and most importantly, transition to value-based care. Clinical integration can also help maintain an edge in an increasingly competitive healthcare landscape. Healthcare organizations can obtain a better understanding of patients and their needs, and map it to available services and facilities to remain at the forefront of their fields.

This paper investigates some of the challenges of moving towards value-based care, and outlines how a strategy for improving the way patient and clinical data is collected, managed, and exchanged can address them. It also discusses Omni-Patient™, an information management solution from Information Builders. Omni-Patient combines integration, master data management, and data quality management with pre-packaged models, for a single view of key business domains that can be leveraged to enhance population health, reduce cost of care, boost revenue, increase operational efficiency, and seamlessly implement value-based business models.

1 Hoover, Waco et al. “Transforming Health Care Through Big Data,” Institute for Health Technology Transformation, 2013.

2 Lorenzetti, Laura. “5 Trends That Will Redefine Your Healthcare Experience in 2015,” Fortune Magazine, January, 2015.

Seven Key Challenges in the Move to Value-Based Care 2

“In healthcare, our charge is to become patient-centered and subsequently be reimbursed based on the value of the care we provide,” says physician C. Matthew Hawkins in a recent Physicians Practice article.3

“This reform will require increasing patient access to medical records, optimizing information sharing across systems, and allowing patients to use mobile devices for scheduling appointments and getting results. Demonstrating value will require aggregation of large pools of patient and cost data with real-time monitoring of results and patient tracking. IS/IT is absolutely essential for this transformation in healthcare.”

In other words, successful adoption of value-based care – or any other new strategies and business models – requires a new level of IT support. Close alignment between IT and the business is key to ensuring a smooth transition to value-based care. However, bringing these two groups together is challenging for healthcare organizations, particularly for their CIOs.

IT organizations can use business intelligence (BI) and analytics to bridge the gap with business users, but these vehicles can’t be successful unless stakeholders are confident that the underlying data is trusted, timely, and complete. CIOs and IT departments also need to rapidly deliver an architecture that easily brings in new types of data to support value-based care and shifting business models. Furthermore, data harmonization must be secure and governable – something existing application-only vendors do not address.

But IT cannot work alone; they must facilitate collaboration among all areas of the business to ensure success. The platform chosen to support any information management strategy must provide business users with consumable views of patient data.

“By truly integrating our IS/IT talent with healthcare strategy, we can begin using our energy towards discovering new, better ways to achieve patient-centeredness and value rather than simply implementing IT tools to avoid payment penalties,” Hawkins concludes.

Challenge #1: Aligning IT With the Business

3 Hawkins, C. Matthew. “Alignment in Health Care: What is Our Strategy?” Physicians Practice, April, 2015.

Information Builders3

“The health information technology revolution has begun, and as it progresses, the shake-up in health information management departments, processes, and data management will leave the profession profoundly different,” according to the American Health Information Management Association.4

“Healthcare and health information management (HIM) professionals have been left sprinting down technology’s trail-blazed path, working to make the most of health IT systems and new data sets that have only just begun to show the true extent of their potential impact on health management and patient care.”

This constant change is evident in the rapidly increasing amount of health information being stored electronically. It is even more apparent when it comes to healthcare codes. Today’s providers work with countless codes and code sets, and ever-changing standards related to those codes.

In the past, HIM was centralized, labor-intensive, and resulted in after-the-fact coding due to fragmented clinical and billing systems, large volumes of notes, and other unstructured data. Recent merger and acquisition activity has changed that. Different hospitals and facilities rely on different information assets, so systems are now much more diverse and distributed. Data quality issues, therefore, must be resolved earlier in the process to positively inform care. This requires data stewardship, with advanced tools for tracking and remediating conflicts, ensuring adherence to governance polices, and driving improvements in data entry processes.

HIM personnel need a single version of the truth for all code and code sets. This can be accomplished with a code set repository managed as a reference data repository, and mastering processes that harmonize all code and code sets and map them properly to each subject.

Challenge #2: Keeping Pace With the Evolving Role of Health Information Management

4 Dimick, Chris. “Health Information Management 2025: Current “Health IT Revolution” Drastically Changes HIM in The Near Future,” Journal of AHIMA, August, 2012.

Seven Key Challenges in the Move to Value-Based Care 4

Data management, particularly integration and data quality, is a critical challenge for enabling deep and precise analytics for providers.

“Healthcare organizations generate increasing amounts of electronic data, as more and more of the process becomes digitized – for example, through e-prescribing, electronic medical records (EMRs), digital imaging scans, pharmacy data, lab data, admissions systems, billing systems, insurance claims data, and regional health information exchanges,” according to American Sentinel University.5 “Yet, information collected in different formats by systems that are not interoperable is likely to yield few insights.”

Today’s healthcare professionals need to address questions that are multi-dimensional in nature. How do we reduce readmissions? Can we close gaps in care? The answers to such complex questions call for longitudinal views of patient information at both the individual and patient registry level across the continuum of care.

Furthermore, data is not truly actionable until it is fit for purpose. Once information is collected and aggregated from various sources, providers must ensure its accuracy, completeness, and consistency. They need a plan and supporting solutions that promote sound data management.

A unified platform for integrating data, managing its quality, and presenting it through intuitive views will greatly increase the productivity of informatics professionals, and will provide the insight needed to promote better patient care and improve outcomes.

Challenge #3: Enabling Advanced Informatics

5 American Sentinel University, “Health Care Informatics: The Trouble With Disparate Data,” The Sentinel Watch, April, 2013.

Information Builders5

According to the American Hospital Association, EMRs alone “do not provide accurate representation of hospital performance.” As incentives shift towards outcomes, value, and quality, providers must place high priority on performance and process improvement initiatives.6

Providers need an extensive breadth and depth of data to understand the complex cause and effect relationships between variations in clinical processes, outcomes, and costs. To improve transparency, accountability, and outcomes, they also need clinicians and administrators to receive metrics and insights in a timely way, and to ensure that they’re based on standardized definitions and trusted data.

Nursing and clinical operations staff face similar challenges, although they now find themselves on the front line for improving patient experience and satisfaction. This satisfaction is crucial to patient acquisition and retention, and tied to various incentives including value-based purchasing. The chief nursing officer needs a timely and integrated view of all aspects of patient care including labs, radiology, beds, medications, and schedules to ensure safety and efficient discharge.

An information management platform that enables the effective management of patient and clinical data will reduce the time needed to gather and analyze data. It will also give all clinical and nursing staff members a single version of the truth about their patients, so they can better improve patient experience and target efforts around patient satisfaction.

Challenge #4: Leveraging Data to Support Process and Outcome Improvement

6 Clark, Cheryl. “Top Healthcare Quality Issues for 2015,” Health Leaders Media, January, 2015.

Seven Key Challenges in the Move to Value-Based Care 6

Medical staff members – particularly the chief medical officer (CMO) – are perhaps the most affected by the transition from fee-for-service to value-based care. CMOs must move beyond measuring physician contributions in terms of volume (RVUs) to viewing their performance across different perspectives such as patient satisfaction, clinical outcomes, and costs. The CMO must also drive the move toward value-based care by reducing waste, such as excessive testing.

“The goal of performance measurement is to understand where physicians are in terms of their performance, and then support programs that drive improvements in both quality and efficiency,” says the National Business Coalition on Health.7 “Improved outcomes that result from performance measurement and improvement can have a direct financial impact for health care purchasers and payers with reduced costs due to avoiding duplicative or unnecessary health services.”

All of this requires richer data across all domains. Clinicians need a solid information management strategy that provides the best possible data to deliver better quality care, more rapidly identify (and close) care gaps, and coordinate care with their peers.

Challenge #5: Measuring Physician Performance From New Perspectives

7 The National Business Coalition on Health. “Physician Performance Measurement & Reporting Introduction,” The National Business Coalition of Health, January, 2011.

Information Builders7

Financial staff also struggles with the move toward value-based care, but from a reimbursement perspective. For large providers, the problem is exacerbated by the need to stay relevant against new competition from urgent care clinics, retail locations, etc. CFOs must be armed with harmonized information, including clinical, financial, and claims data across the continuum of care to secure performance incentives and negotiate favorable reimbursements, performance based contracts, and new payment contracts from payers.

Since many of the new models provide either bundled or capitated payments, CFOs must pay more attention to actual patient costs and the risks associated with different patient cohorts. Furthermore, they must focus on reducing revenue leakage after discharge by increasing the patient’s propensity to not only engage in follow-up care, but to do it within the health network.

Effective information management and integrated patient data gives the CFO a vehicle for vastly improved decision-making. They have the insight they need to generate revenue, reduce costs, and identify profitable growth opportunities through expansion of ambulatory clinics, mergers and acquisitions, and new business models such as ACOs, CLIO, and PHOs.

Challenge #6: Adopting New Incentive and Reimbursement Models

Seven Key Challenges in the Move to Value-Based Care 8

Value-based care requires full transparency into the entire patient journey. But in many health networks, patient information is stored in disparate EMR systems that lack synchronization and interoperability. For example, the application that manages surgeries may not be linked with the one in the pharmacy, making it nearly impossible to manage profitability, utilization, quality, and other metrics across business and service lines or among different physician groups. Clinicians may also be unable to look beyond their own departmental view to get a more complete picture of the patient’s health – something that is required in the transition to value-based care.

A recent article on CIO.com8 claims that while more than $28 billion has been spent on health IT, EMR systems “are not interoperable, meaning that information does not flow seamlessly between them.” The article cites a report by the Office of the National Coordinator for Health Information Technology (ONC), which found that, in the next few years, more than 60 percent of both hospitals and health systems expect interoperability to be one of the top three data-related challenges.

Furthermore, patient information is no longer confined to EMR records and claims transactions. Other external information sources – patient-generated data and disease registry data, for example – also hold valuable insight about patients. An August, 2015 study conducted by the eHealth Initiative shows that the majority – more than 75 percent – of accountable care organizations (ACOs) struggle to collect data from outside their organization, while 62 percent are challenged by data integration. Many of those surveyed lacked integration with pharmacy (30 percent), laboratory/diagnostics (20 percent), hospice (46 percent), and behavioral health (53 percent) information.9

To achieve value-based care, providers must retrieve, consolidate, and manage the quality and consistency of this data from its incompatible formats and siloed sources, then make it sharable with other stakeholders.

Challenge #7: Dealing With Diverse Data Infrastructures

8 Padmananabhan, Paddy. “5 Healthcare Technology Predictions for 2016,” CIO.com, December, 2015.9 eHealth Initiative. “2015 ACO Survey Results Webinar,” eHealth Initiative, October, 2015.

Information Builders9

Omni-Patient from Information Builders is an information management solution that simplifies complex data integration, promotes data quality, and facilitates ongoing data governance to deliver a 360-degree view of the entire patient journey. This single solution unifies data across a wide range of systems to create a single, accurate, and consistent point of reference for the complete clinical history of all patients seen by the health system. Omni-Patient empowers providers to achieve a greater level of governance over EMRs and other information sources, so they have the insight needed to increase efficiency, enhance care management, reduce cost of care, boost revenues, and enable seamless transition to value-based business models.

With Omni-Patient, providers can:

■n Integrate data across a wide range of systems, including EMR applications, HR and financial solutions, and external data

■n Create a multi-level data repository, with mastered subjects, transactional subjects, and a healthcare data warehouse, for a comprehensive view of all patients

■n Promote broad-reaching data governance

■n Ensure effective information distribution to meet proprietary departmental requirements, as well as enterprise needs for health information

■n Generate clinical analytics for patient safety and care quality, and create measures for business volumes and outcomes

■n Obtain a unified view of the patient journey across the patient care continuum to enable proactive planning and coordination

■n Leverage historical snapshots and traceability for a complete audit trail of what a golden or instance record looked like at any point in time.

■n Enable proactive data stewardship with dynamic alerts and a Remediation Portal to let data stewards know when a data quality issue requires manual investigation.

Accelerate Time-to-Value With Nine Pre-Built Business Domains

Omni-Patient organizes all data into nine business domains - clinical, financial, accessibility, patient, provider, payer, facility, organization, and workforce. It includes predefined data quality rules, match/merge rules, process rules, consumption rules, and remediation rules for each domain.

Clinical – Enables analysis of operational volumes and outcomes related to the delivery of care, and facilitates the calculation of industry-standard measures of clinical quality and patient safety. It includes a set of transactional subjects that cover patient care: encounters, diagnoses, orders, observations, procedures, surgeries, assessments, patient satisfaction, medications, immunizations, allergies, chronic conditions and social habits, episodes, and care plans.

Financial – Facilitates analysis of the revenue cycle to support improvements in billing and collections, cost control, and profitability. It includes subjects such as accounts, charges, payments, adjustments, claims, costs, revenues, and expenses.

Omni-Patient: Information Management for Healthcare Providers

Seven Key Challenges in the Move to Value-Based Care 10

Accessibility – Enables analysis of patient demand, provider resource allocation, and referrals into and out of the health system. It includes subjects such as appointments, provider availability, referral sources, and patient wait lists.

Patient – When combined with the clinical domain, provides a complete 360-degree view of conditions, treatments, and outcomes by patient in support of care management analytics. It contains mastered data for a patient, including attributes such as demographics, identity, and address data.

Provider – Used to identify successful providers, as well as those that need additional oversight. It contains mastered data related to providers, who can be physicians or other caregivers, and includes attributes such as specialties, licenses, credentials, certifications, education, privileges, assignments, and provider group relationships.

Payer – Enables the analysis of clinical and financial performance on a payer or health plan type basis. It contains mastered data for payers, health plans, and patient coverages.

Facility – Helps to uncover abnormalities or gaps in performance at specific facilities or locations within them, or by facility types, by supporting drill down into measures on a by-location basis. Includes mastered data about facilities and their internal hierarchy of locations to describe where patient care was delivered and in what setting it took place.

Organization – Enables users to leverage the complete organizational hierarchy for drill-down analytics. It contains mastered data about an organization and its internal departmental and cost center hierarchies, including attributes such as contact information, identifiers, and relationships.

Workforce – In conjunction with the organization domain, enables labor and wage-based operational measures and support analysis of labor demand and availability. It contains mastered data about workers and jobs, as well as transactional data about work hours and pay.

Memorial Health, one of Illinois’ leading healthcare organizations, uses Omni-Patient to overcome

information integrity issues and create a single view of patients, providers, workforce, and facilities in

support of performance improvement goals. Omni-Patient also enables compliance with government

regulations, such as meaningful use guidelines and participation in the Lincoln Land Health

Information Exchange, and facilitates the flow of accurate information across the organization.

“Omni-Patient will ensure that everyone – from clinicians and nurses to financial and administrative

staff – is looking at and analyzing the same data, so our decisions and predictions are always being

made based on consistent, accurate information.”

Tom Janssen, Manager of Enterprise Data Warehousing and BI, Memorial Health System

Information Builders11

Today’s healthcare providers worry about so much more than just regulatory compliance. They need to tap into the wealth of information they manage to enhance service delivery and address competitive pressures, while maintaining profitable operations and striving toward value-based care models.

Providers need capabilities beyond those provided by traditional EMRs to truly leverage their information in the transition to value-based care. They need to ensure data accuracy, completeness, and consistency using a proven, repeatable method that can easily incorporate new applications, partners, processes, and metrics. With effective information management, they can operate in a more agile fashion, rapidly responding to new opportunities and competitive threats, or shifting strategies as needs change.

Omni-Patient from Information Builders combines powerful features and capabilities with pre-built business domains, to enable health providers to create robust, complete data integration and mastering applications. With Omni-Patient, healthcare organizations can rapidly gather, unify, and master clinical, patient, and other data, for a 360-degree view into their most important information assets.

About Information Builders

Information Builders helps organizations transform data into business value. Our software solutions for business intelligence and analytics, integration, and data integrity empower people to make smarter decisions, strengthen customer relationships, and drive growth. Our dedication to customer success is unmatched in the industry. That’s why thousands of leading organizations rely on Information Builders to be their trusted partner. Founded in 1975, Information Builders is headquartered in New York, NY, with offices around the world, and remains one of the largest independent, privately held companies in the industry. Visit us at informationbuilders.com, follow us on Twitter at @infobldrs, like us on Facebook, and visit our LinkedIn page.

Conclusion

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