The pathway to value-based care is paved with good intentions, countless hours of hard work, and government, payer, and provider leadership. Value-based care, sometimes called payment reform, shifts the paradigm of healthcare delivery from a system built on payments for individual services (volume) to one rewarding wellness, outcomes, and lower costs (value). Over a decade of programs championed by the Center for Medicare and Medicaid Innovation, focusing on accountable care and bundled payments, have had some notable successes. Private value-based care arrangements, structured by health plans and state Medicaid departments have had some significant achievements. However, overall, those trying to implement value-based care program adoption and success has been met with many barriers including complex data analyses and novel contracting models.

Payers and providers learned new ways of structuring care, rewarding performance, and developing the tools needed for these new programs. Successful programs require payer-provider cooperation to achieve patient health goals through communication and the sharing of evaluative performance and outcomes data. As value-based care programs develop they often require new, sometimes substantial, investments to participate and succeed. Organizations invested in new resources such as:

• Health Information technologies and infrastructures
• Data acquisition and aggregation platforms
• Analyses to measure and demonstrate the quality of care
• Experts to calculate risk and rewards, develop, implement, and run different types of value-based care programs

Value-based Care Leadership Challenges

Despite investments from the government, payers, and providers to support a transformation to care grounded in value not volume, adoption has been much slower than anticipated. A survey of 1,090 healthcare leaders from across the industry identified several barriers to value-based care program implementation:

• Lack of resources (25.3%) – including staffing shortages and inefficient healthcare IT software
• Gaps in interoperability internally and externally (19.7%) – respondents are deeply concerned about data exchange difficulties
• Financial risk and unpredictable revenue streams (17.0%) – value-based care models are complex and in times of when revenue stability is an issue, understanding the complexities of financial risk is critical
• Shifting policies and regulations (16.2%) – changing measures, programs, and incentives increase difficulties in tracking and implementing programs
• Difficulty collecting and reporting patient information (15.0%) – collecting and analyzing data to understand patient care and gaps in care

High quality clinical data necessary for accurate financial and clinical calculations

Accurate and complete clinical data is essential to the success of value-based care and for the tools to overcome many of the aforementioned barriers. For example, if a health plan is negotiating with a health system about developing a value-based accountable care diabetic population program, the plan will require insights driven by reliable data to determine performance and financial measures. The plan will need to know what services those populations received, what comorbidities they might have, and establish quality outcomes and performance measures to arrive at a fair contractual payment.

That data, however, whether used for quality determinations, risk calculations, or transmitted to another institution or patients, is likely to be inaccurate and incomplete. The barriers listed above will continue as constrained resources try to acquire, analyze, and share applicable data sources and analytics based on “dirty data”. It is hard to calculate value or the quality-of-care, when the data needed for those calculations is not trustworthy.

These problems are not insurmountable. Data curation services that clean, standardize, and normalize data can be used to increase the accuracy, completeness, and usability of the data. Read the new white paper from Verinovum Enabling Compliance: High-quality data provides the foundation for improved care and quality measurement to learn how more complete and accurate clinical data can positively impact your value-based care efforts, care management, and plan performance ratings.