Value-based care has become a buzzword in the healthcare sector, and rightly so. It marks a significant transformation from the traditional fee-for-service model that has dominated healthcare for years. Value-based care focuses on delivering high-quality care that produces optimal health outcomes while reducing costs. This model emphasizes collaboration between payers and providers to achieve better results, with the goal of elevating patient experiences with healthcare data insights.
In our recent episode of The Health/Tech Edge, Productive Edge’s Chief Strategy Officer, Raheel Retiwalla and Sr. UX Content Strategist, Zoe Jacobs, were joined by Amy Berk, Director of Population Health at Microsoft to discuss patient data interoperability and value-based care and how they are shifting the healthcare industry to become less fragmented and more integrated. You may listen to the full conversation here or read their summarized conversation below to learn more about:
- the evolution of healthcare delivery model toward value-based care
- correlation between population health and value-based care
- organizations succeeding at delivering value-based care
- Microsoft’s relationship with and impact on EHRs in advancing value-based care delivery models
- and more
Zoe Jacobs: Amy, you've been on several sides of healthcare as a practicing nurse working in policy and advocacy consulting and education. Can you tell us about the major changes you've seen mostly toward value-based care?
Amy Berk: We have seen the evolvement of care delivery models all the way back from patient-centered medical homes, the accountable care organizations, and now into full, value-based care arrangements, partnerships between providers and payers, and the way in which they facilitate care coordination and exchange of data to meet quality measures for accountability in outcomes. Additionally, there is a greater shift towards reimbursement alignment. Most notably, today we're seeing more partnerships between payers and providers than we've seen before in the past. It’s common now to see large health systems enter the payer market, and vice versa, while payers are becoming more prominent in the provider market. This convergence is in turn causing the healthcare industry to become less fragmented and more integrated, enabling fluid experience and optimized health outcomes that value-based care strives to create.
Raheel Retiwalla: There is a tremendous momentum across the healthcare sector in getting that integration conducted, whether it might be vertical integration happening across the industry, or horizontal, where the payers are thinking about how to best contribute towards the care delivery side or providers thinking about the holistic journey of the patient to make sure that they're able to deliver on the quality metrics and the agreements that they've signed up for with various payers.
It's very exciting to see value-based care progressing towards becoming a scalable program and an increase in organizations participating in trying to prove models that actually work.
Amy Berk: We’re also seeing it in the home care sector. Many of our home care constituents are focusing on becoming value-based as well. When thinking about the evolution of home care, it’s very important to realize that healthcare is no longer within the four walls of a hospital setting. Healthcare is becoming more local and more at the point of care in the home and these home care models, anywhere from traditional home care to comprehensive care management in the home, are now starting to take risks, which is very important, hence the accountability factor in the provision of outcomes.
Raheel Retiwalla: In regards to area of population health and value-based care, how are they intersecting and what are the advancements in gaps that may exist in understanding things like social determinants of health or overall population health to sign up for the kind of agreements and contracts that providers may need to?
Amy Berk: Population health is a large domain and is a framework for how we deliver healthcare today. One commonality of population health and value-based care lies in the data. We can speak to value-based care in terms of legislation. It’s thought of in terms of care delivery and financial components such as making sure that reimbursement is aligned to quality. Population health on the other hand is the framework for how the care is delivered. This is all grounded in the data. How can that data be optimally used and applied in a way to help us better understand our patient populations and in turn evaluate outcomes and course correct interventions to meet the needs of those populations. It's a precursor in how we think about meeting the clinical quality outcomes necessary to advance on reimbursement, and that's exactly where value-based care is aligned. It focuses on closing the gaps in care in order to meet clinical, social, behavioral quality outcomes and reimburse the provider accordingly based on the accountability of the outcomes met.
Zoe Jacobs: Can you provide another example of data interoperability and how you've seen that change?
Amy Berk: Data interoperability has been around for a very long time. I recall earlier in my career working with the Office of the National Coordinator (ONC) on the standards and the interoperability framework in an effort to advance the National Healthcare Infrastructure Network. That interoperability initiative has matured to a new generation of interoperability, leading us to think about Trusted Exchange Framework and Common Agreement (TEFCA), or the regional health infrastructure of networks that are now evolving across the country in alignment with the ONC’s policy initiatives. The grounding of interoperability is as important as it has been since 2010 and the legislation of the Affordable Care Act. However, now there is a visible evolution of TEFCA with even more infrastructure built out, increased commitment to interoperability, creating a greater alignment with payers and providers who are acting upon to advance interoperability in their own practice.
Raheel Retiwalla: In your experience working with companies across the continuum, including payers, providers and specialized accountable care organizations, who is actually doing this really well and what's driving their ability to do so? Additionally, what are the areas that some organizations are struggling with and what could they be doing to participate broadly in value-based care?
Amy Berk: The customers that I work with are each on their own value-based care journey and they're at different points in that journey. There are some that are leaders and those that are catching up. At some point, I do believe that payers and providers are gonna have to get on that journey if they're not already as this is the way forward in healthcare. I would say that Humana is very much a leader in this space and it is the commitment of the CEO that leads them to continue on the journey of value-based care. There are those healthcare organizations that are both payers and providers that are leaders in value-based care as well because they have the organizational infrastructure, in that the healthcare is very integrated between the payer and provider under one umbrella. These include UPMC, Intermountain Healthcare, Kaiser Permanente, the high marks of the world, where there's very robust infrastructure from an organizational perspective but also from a technology perspective, because it is dependent upon interoperability and data to advance on value-based care objectives and broader initiatives. The struggle and lag are most likely within the smaller regional healthcare systems or some of the private healthcare systems who are not as progressive towards value-based care for reasons such as lack of interest, it doesn't align with their mission, or they don't have the infrastructure or the funding. These are some reasons as to why value-based care initiatives might not be advancing as compared to other leaders in the industry.
Raheel Retiwalla: I believe it’s important for even mid-size and smaller health systems to participate as they have their own population health management programs, their intervention strategies, the desire to think about how they can contribute towards the outcomes and how value-based care could be a framework through which they do that. I wonder your thoughts specifically around Epic and other EHRs. What is the role of these organizations and how are they contributing towards the momentum and scale?
Amy Berk: These mid-size organizations may or may not use Epic. If they don't use Epic, they're using Cerner, Meditech, or Allscripts. I will say Epic is leading the charge. Their Epic Care Anywhere platform is really extending the possibilities for data exchange between those providers and payers that have Epic. So there is that continuity of, uh, the provision for value-based care, um, population health, et cetera. providers are probably following suit because of the epic trajectory around exchanging data and the way in which Epic is leaning towards the payer provider relationship.
Raheel Retiwalla: When you think about interoperability and the ability to be proficient at consuming insights that we never had before and being able to act on them, there's a change management and organizational change that needs to happen. What do we do with them? How do we change our workflows that may result from delivering on the outcomes that we would need to drive towards?
Amy Berk: There is so much insight out there that can be gleaned from that data, but how do we make use of that data? How do we understand that data better? I think that there is a gap in that. We are expecting providers, both nurses and physicians, to use data in a way that they hadn't ever used before. There's a learning curve and that's an opportunity, um, whether it be change management, right? As we think about, you know, the education component as related to data, um, but also then really seeking to, um, act on that data for, uh, understanding our members and delivering care.
Zoe Jacobs: Amy, can you tell us a little bit more about your work at Microsoft specifically?
Amy Berk: As Director of population health, I really try to advocate for population health initiatives across both payers and providers and the customers in whom we work with. This means working with customers to really understand their needs around population health and value-based care initiatives and then being able to coordinate and collaborate to develop a strategy that's going to suit them as they advance their value-based care and population health initiatives. Lastly, of course, thinking about how Microsoft's solutions can optimize their population health value-based care journeys.
Raheel Retiwalla: Microsoft is innovating significantly in this area. Even in the last two to three years, there is a great amount of innovation in healthcare across the Azure space as well as the dynamic and the clinical side with Microsoft teams. What do you think about the holistic innovation from Microsoft and how should both payers and mid-size providers think about leveraging the investments Microsoft's making?
Amy Berk: I've been with Microsoft now a little over two years, and when I came to Microsoft, I looked at Microsoft's cloud for healthcare, and I thought “Wow - this optimizes population health in every single way”. Population health and value-based care are grounded in data. Microsoft's cloud for healthcare is grounded in the data, the data lives on this integrated, agile, scalable platform which then activates the various scenarios that we see illuminated around this wheel of goodness. As we think about the capabilities that enable better experience, better insights, and better care grounded in the data, this aligns to the proposition of population health and value-based care. We think about care team collaboration, care coordination, with Microsoft Teams, how we can facilitate data exchange using interoperability to extenuate on value-based care initiatives and better care coordination, and how we can use data to inform ourselves as practitioners about the patients and whom we care for so we can better understand their needs. We then think about the capabilities as aligned to how we better engage with our patients and our member populations. Whether it be by virtual or omnichannel engagement and being more prescriptive and personalized in our care delivery overall. As we think about value-based care and specifically around the quality and reimbursement scheme, we need to ask how we could be more predictive and more accurate around those modeling of contracts. Oftentimes, one of the barriers for value-based care, especially among providers, is that they think that they're not being reimbursed appropriately or accurately. So how can we leverage data and analytics and advanced analytics to really hone in on the accuracy of reimbursement?
Raheel Retiwalla: One of the biggest areas of opportunity is to work and help providers to get a better handle on the insights around the financial modeling and the financial outcomes so that they're well armed with facts. If you’re able to extend that to more predictive capabilities, that's when you can really hone in the right population where you can focus on nurturing the right clinical workflows that you can optimize. I'm also curious about the relationship Microsoft has with EHRs and how are they plugging into the circle of goodness?
Amy Berk: EPIC is on Azure which extends the capabilities of being able to ingest data from various sources beyond Epic around remote patient monitoring and social data as we need it. Having that whole person view of members and patients becomes very important when trying to really understand our patient and member populations and holistically deliver the needs of these groups. We can then use Microsoft's robust reporting capabilities for the evaluation of outcomes, which is a value proposition. Our relationship with Epic serves well for both payers and providers.
Zoe Jacobs: Can you summarize how healthcare companies can prepare to be more interoperable? How can they set themselves up for success?
Amy Berk: I believe it starts with having governance in place and having a vision and mission in mind as they proceed with their value-based care initiatives. Having the right people at the table, including physicians and nurses that have a play in care becomes extremely important. And then of course having proper funding and inserting the appropriate quality and measures and identifying and documenting the appropriate value-based reimbursement schema. Then of course, as we think about value-based care, the infrastructure. It's all dependent on the data and the proper infrastructure in terms of interoperability to advance on the proposition of value-based care.
