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Supporting a Value-Based Approach to Healthcare in the Digital Era

Epiphany Team

To complete its pivot to value-based care, the healthcare industry must adopt a more interconnected, technology-driven approach.

The healthcare industry is in the midst of a major transformation, and at the heart of it all is a shift in how doctors and other healthcare providers get paid. Traditional healthcare payment models follow a fee-for-service (FFS) structure in which third-party payers (insurance companies or government agencies) reimburse healthcare providers based on the number of services they provide. These payments are “unbundled,” meaning third-party payers are billed for each distinct appointment, procedure, or service that a doctor orders for a patient, regardless of the patient’s health outcomes.

As questions about the effectiveness of FFS have become more common, value-based care has stepped into the spotlight. Value-based care represents a more holistic approach to healthcare, taking into consideration the quality, cost efficiency, and results of a patient’s care. Rather than receiving reimbursements for the volume of services they provide, doctors receive payment based on the quality and effectiveness of those services.

Because value-based care is patient-centric — and therefore focused on finding the best solutions for achieving positive health outcomes — doctors are incentivized to not only engage with their patients, but to coordinate their care with other specialty providers. The overall goal of this approach is to ensure each patient receives seamless, high-quality care as efficiently as possible.

How Today’s Technology Enables Tomorrow’s Healthcare

With the shift toward patient-centric care, technologies like wearable devices have become increasingly popular. These devices and their associated apps can be used to monitor and support patients with chronic conditions or patients who are pursuing specific health goals. For example, wearables are already being used to track blood glucose and help prevent at-risk patients from developing type 2 diabetes. They’ve also been leveraged to detect signs of heart arrhythmias, depression, asthma, and more.

Technology is also expected to play a particularly pivotal role in Electronic Visit Verification (EVV). The 21st Century Cures Act, which went into effect in 2016, now requires Medicaid-funded home care providers to electronically record specific data points for every home visit they make, including the type of services provided and when, where, and by whom they were administered.

The primary goal of EVV is to cut down on fraud and abuse, but it can also improve quality of care by ensuring patients receive each of their scheduled visits for the appropriate number of hours. Additionally, EVV technologies allow home care providers to spend a larger percentage of visits actually caring for patients instead of manually filling out paperwork. By streamlining these operations, EVV technologies help coordinate care, accelerate payment processing, and even increase communication between patients and providers.

The Barriers to Adopting a Value-Based Care System

According to the Association of American Medical Colleges, there will be a shortage of approximately 122,000 physicians in the U.S. by 2032. The biggest reason for this deficit is age: more than half of all nurses and physicians working in the U.S. are over the age of 50. These individuals are reaching retirement right as aging Baby Boomers — the largest living generation — are starting to need more and more care. Paired with underfunded software initiatives, this staffing shortage makes it difficult for existing providers to take advantage of value-based IT systems.

Gaps in interoperability also stand to hinder the adoption of value-based healthcare models. The shift toward greater communication and coordination between care providers requires a rapid and efficient exchange of information. But if each provider uses a distinct system, a patient’s records might not be compatible or accessible once exchanged. Adopting interoperable technologies like electronic health records (EHR) is crucial, as these platforms help ensure patient records are accessible to all relevant parties.

Facilitating the Adoption of Healthcare Technology

Despite these barriers, studies predict that 75 percent of healthcare business operations will be aligned under value-based arrangements by the end of this year. Incorporating cutting-edge technology into the healthcare field will facilitate this process, streamlining systems and eliminating inefficiencies to ensure patients receive the care they need and providers get paid.

But even the most advanced technology is only as good as the support systems it has in place. At Epiphany, we work closely with medical device and software providers to ensure their clients across the care spectrum are onboarded properly and that all their end users receive sufficient training. Further, our customers can rest easy knowing that any issues or concerns that arise will be quickly addressed by our experienced, HIPAA-compliant remote IT support team. To learn more about how to conduct a technology rollout that will lay the groundwork for value-based care, contact us today.

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