Committing to a value-based care model requires significant investments – in both time and capital. Organizations need new technology with analytics, care, and payment capabilities that go beyond the capabilities of legacy systems designed for a fee-for-service world. In that world, analytics are nice to have but not critical to the mission of improving population and patient health. Payment technology simply must be able to process a claim for a specific procedure and pay that to a provider. Care tools like EHRs are nice to have, but they can be simple record-keeping tools, rather than tools to support clinical decision making and share detailed data to anticipate and address patients’ needs.
More advanced software today can support the unique goals and initiatives of a VBC world. That means analytics that dive deep into the array of data available on patients and populations to spot critical trends that can impact clinical and financial performance – and alert payers, providers, and employers before they hit the bottom line. AI tools today also provide the capability to anticipate behaviors, such as someone skipping a recommended mammogram or flu shot, so care teams can intervene early to ensure optimal health for that patient. Additionally, predictive AI models can anticipate disease risk for costly and sometimes debilitating chronic conditions, such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD).
Without these tools, payers and providers trying to succeed in VBC are essentially like a pilot trying to fly an airplane while blindfolded – even the best ones will have a very challenging time accomplishing their goals.
Administrative work is necessary in healthcare, but it presents a significant burden to many providers. The costs of adding administrative staff to handle things like IT management, claims and billing, and reporting requirements can be crippling, particularly for smaller and rural healthcare facilities. But these functions are necessary, and without them, healthcare delivery organizations quickly find themselves falling behind in trying to make the shift to VBC.
Fortunately, technology can help here as well. Software tools that automate repetitive processes, such as claims submission, eligibility and beneficiary alignment, prior authorization, and reporting reduce the manual work for administrative staff, and can limit the human resources required to efficiently run a clinical office.
In a fee-for-service world, collaborative care is nice to have but not necessary. That’s part of the reason our healthcare system has become so fragmented over the years. Many patients see a wide range of primary care and specialty care providers, and few of them have the tools or motivation to work together. Collaborative care requires teams to share information on patient health, medical history, test results, and more. Effectively sharing this information can eliminate costly redundancies in care – such as the same test performed at multiple facilities for multiple provider appointments.
However, integration and collaboration require data management tools that seamlessly connect and exchange information in an efficient, usable format. Most data tools are not designed for sharing externally, making this a significant challenge. Cedar Gate’s unique data management system was built for data sharing. It uses AI and other automation tools to ingest, cleanse, and normalize data from dozens of vendors into a single data lake. That information is then shared across our entire platform of analytics, care, and payment software, but it can also be shared with other software systems.
A VBC model relies heavily on coordinated, patient-centered care, which requires adequate staffing across various roles, including physicians, nurses, and support staff. A shortage of healthcare professionals can undermine these efforts by increasing workloads for existing staff, leading to burnout and reduced quality of care.
When healthcare providers are overburdened, they struggle to invest the necessary time and attention in preventive care and patient education, which are critical components of VBC. This can result in poorer patient outcomes, increased hospital readmissions, and higher overall healthcare costs, which are counter to the goals of VBC.
During and after the COVID-19 pandemic, the already-strained healthcare workforce has become even worse, experiencing significant burnout and an exodus of highly trained workers. Experts predict labor shortages to get worse in almost every area of healthcare, from nurses and supporting clinical staff (medical assistants, certified nursing assistants) to home health workers, physicians, and advanced practice clinicians.
Technology can alleviate some of these staffing burdens. Tools like workflow automation, predictive AI, and care management can minimize manual work for care teams and free them up to focus more on patient needs. For example, AI and machine learning models can predict which patients are unlikely to come in for their annual checkup. The analytics software can create a cohort of those patients in a dashboard, where care teams can quickly access the list and contact those patients to get appointments scheduled – all without any manual work to comb through patient charts or compile a list of patients to call.
Value-based care is the future for U.S. healthcare. While there are still significant challenges to its widespread adoption and success, there are also solutions that can help us get there. It requires a concerted effort from all healthcare stakeholders, and a commitment to changing our broken healthcare system. Cedar Gate is ready to help make that shift, and we want you to be part of this healthcare future. The Value Revolution is here. Are you ready?
