As we outlined in the first post in this series, the promises of healthcare IT have not been realized due to the functional and technological disconnects between payers, providers, caregivers and members. These disconnects create an incomplete view of the member’s health and prevents healthcare stakeholders from collaborating effectively to deliver the best care and quality at the lowest risk and cost.
The shortcomings of legacy healthcare IT affects payers, providers, members alike:
- Health plans too frequently leverage information that is isolated inside data warehouses. While they are great for reporting historical information, they fall short in real-time transactional data that can immediately be acted on while events are taking place. Similarly, plans must leverage isolated solutions featuring a complex amalgamation of legacy systems based on antiquated technologies that require a heavy IT resources for ongoing maintenance of the interlocking connectivity. Information from these solutions is not leveraged for actionable interventions and/or requires heavy operational lifts. If this information is not leveraged within the health plan, how can it be extended to outside stakeholders?
- Providers are either operating and making decisions on what information they have collected within their EMR, which is limited to data that they have collected with their four walls or they are being pushed static, dated or non-actionable documents. This limits a cohesive and coordinated care plan for at-risk members.
- Members are receiving episodic based care based on finite pieces of information as opposed to care that involves the whole patient. This raises risk not only for sub-optimal care, but potentially serious adverse events. Patients are also potentially left with false senses of security regarding their health.
Under these conditions, coordinated care outcomes are nearly impossible to realize. To optimize value-based care reimbursement, the IT systems of both payers and providers must be meaningfully connected through advanced technologies.
How Advanced Technologies Enable True Coordinated Care
Recent advances in healthcare IT are merging disparate data sources and enabling seamless collaboration across all stakeholders. Doing so allows for strategically aligned interventions to close care gaps and improve quality scores. When payers, providers, and members alike can access a single, 360-degree view of member care in real-time, the promises of value-based care can finally be realized.
The key features of advanced healthcare IT that allow stakeholders to effectively coordinate care and optimize reimbursement include:
- Integrated Data, solutions and stakeholders. For any healthcare IT solution to be beneficial, it must provide a full, 360-degree view of each member’s care history, including all providers, interventions, prescriptions, and more, all in a single, easy to use interface.
- Artificial Intelligence (AI). AI takes analytics to the next level by integrating member encounter, clinical, and pharmacological data with targeted NCQA HEDIS® measures. Instead of merely analyzing one or two metrics at a time, AI can turn opaque data into meaningful insights into quality performance.
- Real-Time Actionable Analytics. Thanks to the capabilities of AI, health plans can operationalize data and generate actionable analytics in real-time. For example, care managers can clearly see open cases, next-steps, care gaps, and risk exposure, and instantly identify, group, and prioritize members to improve outcomes across multiple quality measures.
- Automation. Using automation, health plans can take immediate action on the insights gained through AI-powered analytics. Care managers can instantly communicate targeted care gap interventions to physicians without needing to maintain or fax spreadsheets. They can also build customized workflow rules and automate communication between providers and members with systematic alerts.
End-To-End Payer, Provider and Member Alignment Is The Answer
Yet, all missed the big picture. True, transparent alignment of every stakeholder is the only way to make a lasting impact on quality, cost and outcomes. To solve this, we created one end-to-end platform called Affinitē. Affinitē brings together the relationship among data, solutions and stakeholders.
It is the first to natively integrate care management, quality, and risk adjustment with provider and member management to get every stakeholder on the same page with quality and care management improvement and cost containment.