Healthcare stakeholders are moving away from fee-for-service and towards value-based models to meet the demands of aging and millennial populations while also meeting an ambitious national healthcare agenda.
Today, regulatory and market forces have led to improved transparency and enhanced consumerization, changing the face of healthcare. These shifting priorities have catalyzed the desire to track patient outcomes and cost-savings for improved quality of care.
The 21st Century Cures Act has accelerated healthcare innovation, technology advancement, and improved interoperability. Passed in 2016, The Cures Act requires that electronic health record (EHR) systems provide patient-facing application programming interfaces (APIs) to maintain federal certifications. In 2020, the Centers for Medicaid and Medicare Services (CMS) issued additional rules requiring that payors and providers who receive CMS funds make health information more accessible.
Ultimately, CMS and the Office of the National Coordinator for Health Information Technology (ONC) aim to improve information access in hopes of facilitating more holistic healthcare, improved quality of care, and better support for broader federal and regional public health initiatives such as disease surveillance and health equity. Overall, regulators have made clear their intention to eliminate barriers to interoperability and provide patients greater control of their healthcare. Shifting the industry from one in which data was shared in accordance with federal privacy legislation, to one in which data is shared at the directive of the patient.
Value-based care (VBC) requires interoperability
Value-based care (VBC), at its core, relies heavily on patient-centric care coordination amongst providers, payors, community partners, and even patients. Access to patient data is essential for the delivery of this comprehensive care. This model—aimed at aligning financial incentives with patient outcomes—requires vast amounts of patient data. Synthesizing this data enables guided care but also presents opportunities to address Social Determinants of Health (SDoH) and health equity, providing avenues to improved, holistic care delivery.
All this is to say that the success of VBC depends on interoperability. Superficially, the concepts of interoperability and VBC may seem distinct. But they are, in fact, synergistic ideals. Because VBC requires an unprecedented amount of coordination among healthcare stakeholders, the success of one is likely to ensure the success of the other. By increasing access and data-sharing capabilities, interoperability standards provide a level of transparency necessary to effectively manage patient-centric care, improving the likelihood of better patient outcomes at lower costs.
This concept of “optimized interoperability” helps healthcare providers use data to better manage clinical performance, deliver more efficient patient care, and improve clinical outcomes. At least in part, the question of value has become a question of cooperative and coordinated (interoperable) care.
The proliferation of EHR systems, coupled with improved data standardization through Health Level 7 Fast Healthcare Interoperability Resources (HL7-FHIR®) have increased the information available to provide VBC. But limitations remain. To improve care coordination, close gaps of care, and accelerate both quality and financial agendas, tactics to access, exchange, and analyze data—in near real-time—from disparate and disconnected systems are required. Thus, VBC sits at a pivotal juncture. Despite important progress, challenges still exist:
- Rising healthcare utilization and aligned patient expectations.
- Shortage of primary care professionals, unequal access to care.
- Uneven investment in healthcare technology.
- Heightened cybersecurity threats.
- Regulatory compliance.
Inaccessible and incomplete patient data creates insurmountable challenges to coordination, financial-risk arrangements, and effective preventative care. As payers, providers, and government regulators all work to standardize programs and processes to overcome these barriers, interoperability will play a growing role.
Despite the challenges, enhanced data connectivity still holds the promise of enabling informed decision-making at the point of care. That can reduce administrative inefficiencies, provide visibility across health systems, enhance member experiences, and bolster preparedness for public health emergencies.
Care delivery’s shift is demanding interoperability
To complicate matters, the steady migration away from hospitals and clinics (institutionalized medicine) and towards community and consumer-centric models of care is accelerating. The shift towards these “distributed models” indicates that a growing portion of healthcare data now sits outside of the traditional healthcare organization. That makes it less accessible to its current EHR systems. Patients—the focus of all programs aimed at quality, value, and outcomes—now demand that healthcare itself (not just its data) becomes more accessible and convenient.
Wearable technologies, home-medical kits for genetics and medical screenings, on-demand telemedicine, and other novel healthcare delivery models are quickly growing in popularity. While these innovations have produced exciting and novel opportunities for the industry to engage and care for patients in meaningful and convenient ways, they also present challenges for the delivery of VBC.
The reconciliation between what is demanded by patients and what is considered “traditional healthcare,” requires thoughtful consideration. From an industry-wide lens, the importance of this cannot be understated. Getting this “right” would be a giant step towards ushering the age of continuous and high-quality well-care, rather than episodic sick care. Harmonization between these increasingly consumer-driven models of care, traditional healthcare systems, health plans, and public programs highlights the need for extensible technology platforms and tools designed with these goals in mind.
A platform for optimized interoperability
Microsoft Cloud for Healthcare provides a platform and tools by which these ideals can be deployed. Fundamental to the platform is the belief that by enhancing a healthcare entity’s interoperability posture, we can make the exchange of data between stakeholders less challenging, and the path towards developing value-based practices less obscure.
Microsoft Cloud for Healthcare provides robust capabilities that simplify data-ingestion and exchange from various traditional and novel healthcare data sources. But the principal purpose of adopting these foundational technologies—those that make interoperability more achievable and lower barriers to creating fluid, secure, and realistic patient journeys—is to place healthcare data near the most powerful and extensible population health platform on the planet, Microsoft Azure. Its standardized structure for data aggregation delivers distinctive capabilities to utilize cloud-native analytic tools for orchestrating and forecasting patient outcomes, generating reports and meaningful visualization of practice-level indicators, benchmarking, and evaluating reimbursement schemas.
The changing nature of healthcare delivery has accelerated our desire to infuse Microsoft Cloud for Healthcare with capabilities that help facilitate distributed care. These approaches hold the promise of supporting continuity of care. Perhaps one day, we can reduce costs for health systems, plans, and public support agencies—costs that are often passed on to patients. By consolidating risk analysis, quality-measure management, scoring, and claims management on a scalable and secure cloud platform, organizations can pave the way for future value-based arrangements. This future provides enhanced visibility and invaluable opportunities to improve care quality, reduce costs, and harmonize the care experience.
The cornerstone of VBC: Interoperability
Cloud interoperability platforms have never been more important as our industry shifts to meet VBC objectives and maintain financial solvency. These goals require increasingly data-driven approaches to care. Intentions matter, and our platform was built with the realization that when solutions are designed to deliver personalized and integrated experiences to patients, they have the potential to increase provider productivity, engage patients and caregivers, enhance quality, improve affordability, and expand access to care.
Microsoft Cloud for Healthcare was built with the understanding that interoperability is the cornerstone of VBC. It empowers users to take a giant leap towards continuous, integrated care. It was built with the belief that healthcare interoperability is far more than a buzzword. The firm belief that at the core of every patient record sits a life, that life representing an individual’s story, and that every story must matter in our journey to delivering equitable and valuable healthcare.