The crucial role of interoperability in driving value-based care transformation
By Celestino Garcia | September 18, 2023
“It’s about the entire ecosystem,” said Bob Segert, chairman and CEO of athenahealth. “We can think of physician, patient, and technology. But it’s also the pharmaceutical companies. It’s the labs. It’s the inpatient visits. It’s the outpatient visits, and it’s the payers.”
‘All the information you need’
Interoperability is essential for obtaining the extensive information needed to understand a patient's complete healthcare journey. Scott Middleton is founder of SC House Calls (SCHC), a network of doctors, nurse practitioners, and physician assistants who see patients in their private residences, skilled nursing facilities, clinics, and via telemedicine. He put it succinctly when talking to the providers in SCHC’s practice group, saying: “I’m not going to tell you how to practice medicine. I just want to make sure you have all the information you need.”
But how do they get that information?
Middleton admits that self-reporting isn’t always going to yield the most complete or sometimes even accurate patient information, but “by having many care team members involved and connected to one another, the full picture comes into clearer focus.”
Through interoperability, clinical teams use integrated data from various sources — including electronic health records (EHRs), laboratories, pharmacies, and care management platforms — to create a holistic, longitudinal view of patient care and status. This comprehensive view allows for accurate care gap reporting while also helping to identify gaps in preventive care, screenings, and follow-ups.
“We look at things from our Medicare data, like the likelihood of hospitalization,” Middleton said. “I can also see the number of times I’ve seen the patient, if they had a pharmacy consult, if [the payer] wants me to check something off. All this information helps providers decide when we need to see a patient; we can’t just wait for the patient to show up with a complaint.”
Interoperability also empowers providers to set appropriate quality targets by leveraging comprehensive data insights, driving continuous quality improvement initiatives, and fostering positive patient experiences. “When concise information is in one place and is treated in a way that we can actually make better clinical decisions, that’s when we actually make a difference in patients’ and clinicians’ lives,” said Clive Fields, M.D., co-founder and chief medical officer of VillageMD.
Enhancing clinical and financial success
By reducing the complexity associated with accessing and sharing patient information, interoperability allows healthcare providers to focus on delivering high-quality care rather than navigating disparate systems and data silos. The resulting streamlined workflows and reduced administrative burden enables healthcare teams to make timely and well-informed decisions. Real-time access to accurate and up-to-date patient information also empowers healthcare providers to develop personalized treatment plans and monitor patient progress effectively. This, in turn, leads to improved care quality, reduced medical errors, and enhanced patient safety, ensuring clinical success.
Despite the positive clinical implications, some organizations report it isn’t uncommon to encounter resistance to interoperability among providers who are concerned about the expense to achieve it. Yet, interoperability can actually improve financial viability in value-based care.
Payer integration, which can be achieved through interoperability, gives healthcare providers a full-claims view of the patient. This comprehensive view ensures more accurate and up-to-date patient risk scoring, which provides the basis for payment — and the path to financial viability — for practices under a value-based care model. By efficiently exchanging claims and reimbursement data between providers and payers, interoperability also streamlines administrative processes, reduces billing errors, and optimizes revenue cycles. This integration allows payers to evaluate provider performance based on standardized metrics, incentivizing high-quality care delivery while managing costs effectively.
Fostering community partnerships through interoperability
Interoperability fosters community partnerships that are instrumental in supporting patients with chronic illnesses who require multiple touchpoints across the care continuum. By facilitating the exchange of patient information with community organizations, home health agencies, and other care settings, interoperability reinforces effective care coordination and smooth transitions of care. For example, a chronically ill patient's primary care physician, specialists, and home health agency can collaborate through interoperable systems to ensure a coordinated approach to care delivery. This multidisciplinary collaboration across the community not only improves patient outcomes but also reduces duplicative services, enhances patient satisfaction, and gives patients a sense of agency in their care.
Interoperability is vital to the future of VBC
Interoperability serves as the backbone of successful value-based care initiatives, enabling a holistic, longitudinal view of patient care, ensuring both clinical and financial success, facilitating payer integration, fostering community partnerships, and simplifying the practice of care. The secure exchange of meaningful, actionable data empowers healthcare providers to deliver personalized, high-quality care while reducing costs and improving patient outcomes. As the healthcare industry continues its shift towards value-based care models, prioritizing and investing in interoperability will be vital for transforming healthcare delivery, enhancing patient experiences, and building a more efficient and sustainable healthcare system.