Driving with the Rear View Mirror: Interoperability and Value-Based Care
Are we talking to one another yet? That was the key question asked in the Washington Health Alliance and Bree Collaborative’s second Framework for Action Webinar in 2022 titled, Interoperability: Continuing to Remove Barriers to Value-Based Success. Based on the presentations and panel discussion, it’s not clear we have the answer or if that’s the question we should be asking.
As David Lansky observed in a recent Health Affairs article, “It’s time for a wholesale replacement of our system for measuring health care quality and putting quality information to use. The current retrospective, transactional system for measuring and rewarding improvement is ineffective, expensive, burdensome, no longer credible, and does not measure health or the outcomes of health care.”
Ginny Weir, the Chief Executive Officer of the Foundation for Health Care Quality and Director of the Bree Collaborative opened the webinar by identifying one of the biggest barriers to interoperability is the lack of trust among the various health care stakeholders.
Each stakeholder group has its own sources of data, priorities, goals and needs with respect to sharing that data. To address those issues, the National Academies of Medicine brought together three stakeholder working groups; the Patient and Family Leaders, Health Care Executives, and Research and Research Oversight Leaders (which was co-chaired by Alliance Board of Directors member Sarah Greene until May 2020) to produce a Special Publication, Health Data Sharing to Support Better Outcomes: Building a Foundation of Stakeholder Trust, with key priorities to advance more data sharing and value-based payment adoption.
Keynote speaker, Dr. Jan Berger, President and CEO of Health Intelligence Partners, a health IT strategy consulting practice specializing in integration efforts for populations with complex care needs, likened the lack of interoperability and value-based care as “driving forward using just the rear view mirror.” Berger, who was a primary care physician, academic executive, an executive across all of the stakeholder groups, and employer representative said, “None of us want to be rudderless in moving forward with value-based care, it’s not how we’re going to get success.”
In looking at how Washington state is doing with interoperability, Cathie Ott, Information Technology Strategic Advisor at the Washington State Health Care Authority called “Are we talking to one another yet?” an “interesting question,” but said “the more important question is, ‘Are we hearing each other yet?’” “Interoperability is one of the most complex and challenging imperatives for health care,” adding that she is seeing both payer and providers who are investing in interoperability with AI, machine learning, telehealth, and security.
Ott described several accomplishments over the last year at HCA, in particular, increasing the use of electronic health records, standardizing data sharing, and developing patient identifiers across systems. Ott says the more important question is, “How are we using those data yet?” because the capacity to share data alone “is not enough.” “Are they able to interpret that data and actually use those data in their workflows and for the outcomes on the value-based payment side that really translate into quality benefit for clients and cost containment?”
HCA Chief Data Officer Vishal Chaudhry expanded the rear view mirror analogy beyond interoperability to how care is delivered throughout the health care system. “It’s like looking at the dashboard to drive the car forward without looking through the windshield to see what’s in front of us.” Chaudhry said “there is too much reliance on just the data of what’s happening right now and trusting it will take us to where we think need to go, without being exactly clear on where we are headed.” As a system, Chaudhry said, “just being in the car and looking at the dashboard is not enough, we need to evolve to the point where we are actually putting the path forward so we can look through the windshield and say ‘this is where we’re headed, this is where we need to go.’”
One Health Port CEO Rick Rubin agreed. Rubin said the problem is not whether we’re talking to each other, the question is whether we are “talking about the right things.” “We need to move from a concept like interoperability to a much more specific conversation, like, ‘What is the problem we are trying to solve?’ That’s where the opportunity lies.” Rubin said “there is enough basic capability for us to do a lot of things,” and he suggested that we consider our current capabilities and define our priorities as a community in order to advance value-based care. “If we had that conversation, I think we could make a lot of progress.”
One example of a full capitation model was discussed by Medical Director of Central and East Regions for Vera Whole Health Dr. Marla McLaughlin. The effort, launching on July 6th in Columbus, Ohio for 32,000 J.P. Morgan employees and dependents, faced significant challenges, particularly in creating the required infrastructure. McLaughlin acknowledged that “value-based care is a better way to deliver care and it aligns financial incentives,” but she acknowledged the limitations of existing data. “Taking global risk on a population, we really need the prospective analytics on this whole population that we’re taking care of and not just the retrospective.” McLaughlin said she is hopeful that Vera’s recent merger with Castlight will bring the prospective analytics needed to support the effort.
Strategic Programs Manager for Premera Blue Cross Sakshi Jain says Premera has been successful implementing more value-based payment models with key provider groups who have the bandwidth and the capacity, but agrees that “the upfront financial cost of investing in the interoperable pathways and channels” can be a significant barrier to more widespread adoption.
If you missed the webinar, you can view it and all previous Framework for Action webinars on value-based care on the Alliance’s website here.