Can Interoperability Drive Value-Based Care?

As the drive to interoperability has evolved over the last few decades — and those of you who are HIT veterans know that these concerns go at least that far back — open data sharing has gone from being a “nice to have” to a presumed necessity for providing appropriate care.

And along the way, backers of interoperability efforts have expanded their goals. While the need to support coordinated care has always been a basis for the discussion, today the assumption is that value-based care simply isn’t possible without data interoperability between providers.

I don’t disagree with the premise. However, I believe that many providers, health systems and ACOs have significant work to do before they can truly benefit from interoperability. In fact, we may be putting the cart before the horse in this case.

A fragmented system

At present, our health system is straining to meet the demand for care coordination among the populations it serves. That may be in part because the level of chronic illness in the US is particularly high. According to one Health Affairs study, two out of three Americans will have a chronic condition by the year 2030. Add that to the need to care for patients with episodic care needs and the problem becomes staggering.

While some health organizations, particularly integrated systems like the Cleveland Clinic and staff-model managed care plans like Kaiser Permanente, plan for and execute well on care coordination, most others have too many siloes in place to do the job correctly. Though many health systems have installed enterprise EMRs like Epic and Cerner, and share data effectively while the patient remains down in their system, they may do very little to integrate information from community providers, pharmacies, laboratories or diagnostic imaging centers.

I have no doubt that when needed, individual providers collect records from these community organizations. But collecting records on the fly is no substitute for following patients in a comprehensive way.

New models required

Given this history, I’d argue that many health systems simply aren’t ready to take full advantage of freely shared health data today, much less under value-based care payment models of the future.

Before they can use interoperable data effectively, provider organizations will need to integrate outside data into their workflow. They’ll need to put procedures in place on how care coordination works in their environment. This will include not only deciding who integrates of outside data and how, but also how organizations will respond as a whole.

For example, hospitals and clinics will need to figure out who handles care coordination tasks, how many resources to pour into this effort, how this care coordination effort fits into the larger population health strategy and how to measure whether they are succeeding or failing in their care coordination efforts. None of these are trivial tasks, and the questions they raise won’t be answered overnight.

In other words, even if we achieved full interoperability across our health system tomorrow, providers wouldn’t necessarily be able to leverage it right away. In other words, unfettered health data sharing won’t necessarily help providers win at value-based care, at least not right away. In fact, I’d argue that it’s dangerous to act as though interoperability can magically make this happen. Even if full interoperability is necessary, it’s not sufficient. (And of course, even getting there seems like a quixotic goal to some, including myself.)

Planning ahead

That being said, health organizations probably do have time to get their act together on this front. The move to value-based care is happening quickly, but not at light speed, so they do have time to make plans to leverage interoperable health data.

But unless they acknowledge the weaknesses of their current system, which in many cases is myopic, siloed and rigid, interoperability may do little to advance their long-term goals. They’ll have to admit that their current systems are far too inward-looking, and that the problem will only go away if they take responsibility for fixing it.

Otherwise, even full interoperability may do little to advance value-based care. After all, all the data in the world won’t change anything on its own.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

3 Comments

  • Let make it easy:
    1. ACO’s are dead*
    2. Managed care, Value based care, all more expensive than FFS.
    3. Value based care is an empty buzzword promise. MACRA is doomed.
    4. Interop is nowhere near useful.

    * http://bit.ly/2h2DnIz (Kip Sullivan gives a good report on the total failure of ACOs and MA plans)

  • It seems to me that interoperability has become the holy grail of HealthIT. As Anne makes clear, even if that is achieved we’ll not be that much closer to HealthIT nirvana. But it can, and will save lives, and allow for some savings, and some improvement in actual healthcare. A couple examples; patient has orthopedic problems, goes into one hospital (A) for a variety of imaging and treatment. Weeks later, ends up in another hospital’s (B) ER, and they, not having access to any of his medical records, waste a fortune (not to speak of the extra radiation) redoing all the imaging. 2nd example; a patient is scheduled to go into hospital B for outpatient treatment. The evening before, patient’s medical situation requires going to the hospital asap via the ER – but the roads are icy from a storm and the ambulance diverts to hospital A’s ER. But A has no access to B’s records, and other then emergency support the patient waits 3 days for the treatment orders to arrive by mail or fax – even though the hospitals are maybe 20 miles apart. Bad for the patient, and very expensive, so just getting interoperability will really help. But the whole issue of ACO and value based care is far more complex; our system has been built on the premise of making health care as expensive and profitable (including pay to executives) as possible. No one gets promoted for cutting costs; they get it for finding the donation for a new building or scanning center. They’d rather build a new, larger ER (hospital B above) then fix the patient flow and related issues that make the existing ER a quagmire. That new ER will quickly be just as bogged down, just as overloaded. And just passing new laws mandating ‘savings’ won’t change the mindset.

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