Data Sharing & Access in the Age of Value-Based Care

Data is one of the most critical aspects of value-based care success. The shift away from fee-for-service models that do not improve overall care quality or focus on patient outcomes is increasing. But as organizations make that shift, they must be able to take on risk in value-based care (VBC) programs. To do that effectively while still meeting financial performance goals requires data.

The good news for many healthcare organizations, and for the future of VBC, is that we have troves of data available. The bad news is that most of that information exists in siloed systems and is only accessible to the organization that initially captured it. For providers, payers, and employers to work collaboratively toward better health for members and patient populations, they must be able and willing to share the data.

Data Sharing Challenges in U.S. Healthcare

Most healthcare stakeholders understand well the roadblocks and barriers that exist in trying to share data, which can include:

• Interoperability issues: Healthcare data exists in millions of databases and a wide variety of organizations, from provider clinics and hospitals to payer databases, software vendor databases, and government databases. Each of these was designed and configured for a specific use and may not be compatible with other organizations.
• Standardization: Similar to the interoperability issues, there is no single standard for ingesting, storing, and reporting patient data. That complicates efforts to integrate it into a single source and glean meaningful insights from the resulting dataset.
• Data privacy and security: Healthcare has strict regulatory requirements to protect patient data (under HIPAA laws) and sharing data among organizations can add complexity to an organization’s ability to comply. Regulations also require patient approval to share data, adding another layer of complexity. Additionally, sharing data among multiple organizations increases the risk of a data breach.
• Proprietary data protection: Many organizations that collect patient data view it as proprietary, and potentially also as a competitive advantage. These organizations often resist data sharing efforts because it can impact business operations. This lack of trust complicates collaborative care efforts.
• Legacy technology and resistance to change: Sometimes the barrier is as simple as an organizational culture that is resistant to change. Implementing software with the capability to seamlessly share across organizations costs money and takes time. If something is working (even if it could work better), leaders may be hesitant to rock the boat.

Why We Must Overcome Data Sharing Barriers

Success in a value-based care system requires that healthcare organizations collaborate to provide optimal care at the lowest cost for every patient. The benefits far outweigh the challenges, and now is the time to push ahead toward a collaborative, coordinated care future.

Improving Care Coordination

One of the primary benefits of data sharing in value-based care is improved care coordination. In a value-based system, providers are rewarded for the quality of care they deliver, which necessitates a holistic view of a patient’s health history and current treatments. Access to comprehensive data allows healthcare providers to see the full spectrum of a patient’s interactions within the healthcare system, including visits to specialists, hospital admissions, and medication history. This integrated approach ensures that care plans are cohesive and that providers can identify and address gaps in care. This continuity of care is also essential in managing chronic conditions – which contribute to most of our healthcare costs today – and improving long–term health outcomes.

Facilitating Evidence-Based Decision Making

Access to a broad dataset enables healthcare providers to practice evidence-based medicine. Advanced analytics from a diverse patient population helps healthcare organizations identify trends, evaluate the effectiveness of treatments, and make informed care decisions. This approach also facilitates more personalized care plans addressing the unique needs of each patient.

More comprehensive datasets also facilitate analysis to refine clinical guidelines, optimize treatment protocols, and ensure that patients receive the most effective and efficient care possible. In a value-based care model, where reimbursement is tied to patient outcomes, utilizing data to drive decision-making is fundamental to achieving success.

Reducing Costs and Eliminating Waste

Value-based care models emphasize cost efficiency, and data sharing plays a critical role in identifying areas where payers, providers, or employers can impact costs without compromising quality.

For example, data analytics can reveal instances of duplicate testing, unnecessary procedures, or high-cost utilization, which can then be addressed through better care coordination or patient education. Furthermore, predictive AI models, powered by comprehensive data, can identify patients at high risk of costly complications. Early intervention for these patients can prevent hospitalizations and other expensive medical interventions, ultimately reducing overall healthcare costs.

Data Sharing is at the Heart of VBC Success

In the pursuit of VBC, data sharing and access are indispensable. They enhance care coordination, facilitate evidence-based decision-making, reduce costs, and improve patient engagement and satisfaction. Addressing data sharing and data access challenges requires a multifaceted approach with advanced technology designed for a value-based care world, regulatory compliance, cultural shifts, and financial investments. By overcoming these obstacles, healthcare organizations can realize the full potential of data sharing, leading to improved patient care and outcomes.