Value-based care is a new model of healthcare that emphasizes better
patient outcomes at a controlled cost. Instead of paying organizations
and physicians based on the volume of procedures they perform
(fee-for-service), value-based care rewards good outcomes, efficiency,
and patient satisfaction. Value-based care should lead to better
outcomes by incentivizing the care that adds the most value over the
care that only yields quantity or volume.
Custom software
solutions can help to further value-based care by developing solutions
to overcome unique obstacles that emerge with this care model. For
example, we help our clients develop tools to manage complex data
better, better engage their patients and care teams so that they, too,
may understand the value-based care approach, and integrate analysis
management and measurement into the existing workflow, which in turn
enhances the efficiency and all-around quality of care.
In this
blog, we examine the crucial role that customized software solutions
play in developing value-based care models. We discuss how these
technologies are helping to enhance data management, improve patient
engagement, support the coordination of care, and performance reports,
all of which are key to the success of value-based care.
Value-based care is a model for healthcare delivery that centers on
the value of care provided rather than the volume of services
rendered. At its core, value-based care is about the patient. It's
about improving patient outcomes and the experience of care while also
decreasing costs. Through this model, incentives are aligned to reward
providers and practitioners for the quality and efficiency of care
delivered rather than the volume of services provided. At its best, a
value-focused healthcare system shifts the paradigm to one that
emphasizes prevention, focuses on the needs of the patient, and
provides care coordination across multiple care settings. This system
incentivizes health maintenance and long-term wellness by shifting
financial rewards to patient health outcomes.
By contrast,
fee-for-service models – which still dominate in most settings and pay
for volume, not value – tend to encourage more services and tests
being done, perhaps needlessly, more than once, or in a
non-integrated, additional manner. Why? Providers can be paid for each
piece performed. That can create incentives for more tests and
procedures that might not be performed or might be performed
differently or less skillfully. Such a system can also entail higher
costs, with more tests and procedures needing to be done repeatedly
and with less coordinated, integrated fragmented care, such as high
blood pressure being treated by the pediatrician, primary care
pediatrician, cardiologist, and pediatric cardiologist.
Value-based
care presents many advantages to patients, providers, and payers. For
patients, value-based care translates to more coordinated and
comprehensive care that focuses on preventative care and improves
health outcomes through better management of chronic conditions. The
financial incentives that come with value-based care can help
providers further streamline their practice management and improve
patient satisfaction. For payers – like health insurers and government
health programs – the use of value-based care not only improves
patient outcomes but also reduces healthcare costs. The focus on
preventive care and improved patient outcomes tends to reduce the
number of hospitalizations and overall spending, providing a more
cost-effective healthcare system. In all, value-based care shifts the
current state of the US healthcare system toward one that more
efficiently and effectively provides patients with the value they and
their physicians desire to reduce costs.
There are many challenges in transitioning to value-based care for
health organizations, many of which are from the fundamental shift
from quantity to quality care. One such challenge is the handling and
analysis of huge amounts of data for effective implementation and
monitoring of value-based care. Care quality can be assessed and acted
upon only when data are brought within a health organization to
measure care outcomes and patient satisfaction, including data from
electronic health records (EHRs), administrative claims, and other
data sources from patients, EHRs, and wearable devices. Various
entities within the health ecosystem can generate large amounts of
data that need to be interfaced, integrated, and analyzed to help
remove gaps in care. These are all challenging activities, given the
complexity of the data sources, volumes, and variability in
formats.
A second obstacle is patient engagement, fundamental to
value-based care and requires active patient involvement and
cooperation with treatment plans. Lack of communication and good
education about risks and self-care options sometimes complicate the
treatment process. Value-based care requires patients to receive the
information they need and be motivated to become active in their
health management. However, many still report feeling left out of
their care, unaware of their roles and responsibilities under the new
value-based model, and without ways to help manage their health.
Care
coordination can similarly be a barrier to value‑based care.
High‑quality care coordination for complex chronic conditions and
patient-centered care delivery requires a coordinated, well‑integrated
effort across providers, settings, and specialties, with minimized
redundancies, glitches, miscommunication, and gaps in care
provision.
Sound technology solutions can overcome these
obstacles, enabling greater data management, patient engagement, and
care coordination. For example, custom software can be written or
provided that integrates data from multiple silos, provides patient
education and communication, and schedules patient appointments and
provider follow-up with other caregivers. Healthcare technology
providers can utilize various advanced technologies and solutions
designed specifically for the sector to overcome these obstacles and
help create a successful value-based care model. This model can result
in improved patient outcomes and more efficient provider operations.
Custom software enables better data management and integration, which
is especially important for the complexity of value-based care. This
includes using technology to enable healthcare organizations to easily
and quickly collect, store, and utilize data from different sources
and make the data more accessible to front-line providers. Custom
software can use data obtained from electronic health records, health
information exchanges, and other systems to develop a more holistic
view of a patient’s health status and to provide the right information
at the right time for making better decisions about care and
coordination of care.
Electronic health records (EHRs) form the
digital backbone of modern, evidence-based healthcare by capturing
ever-growing amounts of patient information, making that data easily
accessible for healthcare providers, and streamlining workflows.
Custom software solutions add functionality to EHRs by integrating
them with other systems, such as laboratory results, imaging reports,
patient-generated data, etc., to combine all relevant information into
one place. This further minimizes errors and treats the whole patient
rather than simply dealing with singular health issues.
HIEs
support data integration by exchanging patient information through
secure transfer across clinical organizations and systems. Custom
software can play a role by supporting better integration, seamlessly
exchanging or matching data that aids the synchronization of outcomes
between systems and interfaces of the EHR and potentially facilitating
better coordination of care (providers can view all medical records of
a patient at any time regardless of the patient was treated).
The
information is readily available, making it easier for healthcare and
ensuring accuracy. This heightened ability allows healthcare providers
to prepare better, representing, more importantly, proper care, which
will be essential for our fractured and frazzled healthcare system to
succeed. Preventing illness from occurring in the first instance will
diminish chronic health conditions and significantly lower spending.
High-quality, patient-centered care requires excellent care
coordination and communication among the entire healthcare team.
Custom software solutions aim to help accomplish this by bringing
together distributed teams in consistent, integrated, and connected
relationships for effective and efficient information exchange and
care coordination.
Another main feature of custom software is
secure messaging. Communication between diagnosticians and healthcare
providers enables real-time information sharing, asking and answering
questions, obtaining approval, and decision-making. It aids them in
their work with each other, and it helps to avoid misinformation,
especially given that patient information differs from person to
person. The main difference is that secure messaging systems encrypt
information, which allows pharmacists and nurses to communicate and
share updates and fine-tune treatment plans with others in this way.
Secure messaging is also necessary to protect patient data and abide
by privacy laws. By having this ability to communicate instantly in
the industry, professionals are able to make critical decisions in a
timely manner.
Care plans are another vital type of structural
aspect supported by custom software solutions. Care plans (sometimes
called care maps or care plans) are personalized roadmaps describing
pertinent goals and treatment approaches for a single patient. These
care plans are designed to build up a holistic picture of the patient
across their healthcare journey. While information on medical
prescriptions and appointments may be stored on a patient’s clinical
file, care plans are used to combine all pieces of information in a
more detailed and flexible manner for implementation. When care plans
are centralized in a digital format, custom software can ensure that
all members of providers and primary care providers, as well as
nurses) can access the same information on each patient’s care plan.
This creates greater scope for coordination – with everyone
potentially involved in a patient’s care being able to go back and
review the care plan and contribute to different areas in a more
unified fashion.
Customized software with integrated task
management capabilities may also help with care coordination by
permitting the tasks associated with a patient’s care to be assigned,
tracked against deadlines, and completed promptly. The organization of
roles and responsibilities is facilitated by these systems, ensuring
that plans of care are followed through and helping avoid the omission
of important phases of the care experience by design and not by
default. Having clear insight into what tasks are outstanding can also
facilitate follow-up and continuity of care.
Software solutions
that assist in providers-patient interactions can take simple or
complex forms. For example, a patient portal is a password-protected
online space where patients can interact with most care team members,
access their health records, schedule appointments and prescriptions,
and send secure messages to their providers. Telemed solution:
clinicians can deliver remote care to patients through video
technologies, exchanging relevant healthcare information online and
tracking clinical progress while sparing unnecessary and discomforting
visits. Patient portals and telemedicine solutions increase patient
engagement and access to care, as well as all providers and their
patients, and help overcome geographical barriers.
Value-based care is rooted in patient engagement. Engaged patients are
much more likely to make their treatment plans as effective as
possible. They are also more likely to follow prescribed care plans,
participate in disease prevention measures and self-care techniques,
and remain proactive in managing their health issues. A successful
value-based care model that reduces costs and improves quality and
outcomes must involve patient engagement.
Custom software
solutions designed specifically for healthcare can help increase
patient engagement and empowerment to improve patient experience and
quality of care and reduce readmissions. One of the most helpful
features of custom software is the patient portal. A patient portal is
a secure online website that provides direct access to patient health
information, such as medical records, lab results, medications,
appointment schedules, and the ability to request refills of
prescription medications. It is accessible from computer or mobile
devices and provides a secure sender-to-recipient connection. It also
allows patients to communicate directly with their health team.
Patient portals help to increase patient empowerment, whereby patients
take a more active role in self-care with the help of their care team.
Direct access to health records through a patient portal helps
patients and healthcare providers communicate more easily.
Mobile
apps have also been shown to be beneficial for patient engagement.
Various mobile health-related apps – from those that capture
physiological data to those concerned with patient education and
appointment reminders – can be used to improve patient outcomes. For
example, mobile health apps can provide patients with real-time health
status updates because they can capture real-time vitals or subjective
experiences, track specific symptoms, and better organize and
coordinate multiple medications. Moreover, modern mobile health apps
paired with wearable devices can collect health and anthropometric
data and transform it into useful health information about physical
activities, body composition, and other patient-centered outcomes.
Aspects
such as tracking patient progress or personalizing health
recommendations are part of patient empowerment. Custom software
offers tools for consequential patient tracking, such as digital
health diaries and progress dashboards. Thus, patients and healthcare
providers can monitor changes in health metrics, adherence to
treatment measures, and indicators of health progress. Based on this
data, recommendations about lifestyle changes or condition management
can be made to patients according to their needs, preferences, and
required direction.
Analytics plays a key role in value-based care models in assessing and
improving care. By analyzing data, organizations can understand the
efficacy of care, spot improvement opportunities, and tweak
data-driven decisions to enhance patient outcomes. Data-driven care
can establish performance benchmarks, track outcomes, and refine care
administration.
This high-level reporting and
performance-tracking capability is a crucial feature of custom
software solutions integral to the conduct of aggregate, longitudinal
analysis during which controllable factors are identified and
opportunities for improvement are seized upon within the practice.
Custom software furnishes the dashboard and report capabilities needed
to view all types of data – from simple feedback measures like patient
satisfaction scores to far more complex clinical outcomes, financial
performance, and other factors that healthcare organizations aim to
track to achieve their strategic aims. By making this data more
legible and ‘problematical’ – providing it in an accessible or
actionable form – custom software helps providers better understand
the condition of their practice and strike upon opportunities for
continuous improvement.
Custom software tools that utilize data
analytics enable healthcare organizations to discover trends and
patterns in patient data. Analytics can identify trends for patient
conditions, treatments, and adherence to healthcare plans over time.
It can also provide insight into underlying issues – for example, gaps
in care or critical intervention needs – that providers can then
target in their care provision. Identifying these patterns before they
emerge allows care providers to improve care and intervene at the
right times.
Together, performance measurement and optimization
are enhanced by incorporating data analytics tools to measure outcomes
and optimize care delivery. Customized software is set up to track
various key performance indicators, or KPIs, and quality metrics, such
as readmission rates, patient safety events, and adherence to best
evidence-based practice guidelines. Then, as interventions are
delivered, these metrics are continuously monitored to see how they
shift in real time – as an indicator of individual performance and as
a signal to calibrate performance over time. Analytics can also be
harnessed to optimize care delivery by identifying best practices,
standardizing workflows, and optimizing the efficient application of
healthcare resources.
Since custom software solutions for value-based care are an evolving
landscape, new trends and innovations will likely emerge in the coming
years. As the landscape continues to evolve and mature, these
advancements will have the power to improve the experience, outcomes,
and efficiency of value-based care models.
Perhaps the most
promising-based care custom software involves advanced artificial
intelligence (AI) and machine learning. These technologies, involving
high-powered computation, are increasingly being used to harness
healthcare data collected from electronic health records (EHRs) and
other sources and to identify patterns that can predict patients’
needs. AI-powered tools can assist with risk stratification and help
clinicians identify patients likely to need additional support or
interventions. The tools can also make treatment recommendations that
can be tailored to patients. All of this is possible through the
growing sophistication of predictive analytics at a scale that is
impossible for humans without access to such technology. The
predictive capabilities found in AI assistants coherently and
responsibly support the goal of proactive care management. They can
help providers efficiently focus on the areas where their efforts can
impact most.
As a counterexample, blockchain technology is
another innovative area that ensures interoperability and secure
health data management. The distributed ledger and immutability of
blockchain provide a framework for a robust solution to overcome the
challenges of data security and interoperability; with the ability to
ensure secure data sharing and include more effective patient consent
management, blockchain technology will allow for better care
coordination and the integrity of patient information. This innovation
can change health data from a phenomenon that isolates us to one that
connects us.
Telemedicine and remote patient monitoring will be
additional components destined for the value-based care environment.
The capabilities of telehealth platforms are also growing with
cutting-edge technology and advancements. It is becoming feasible for
patients to receive almost entirely comprehensive remote
consultations, diagnostic data gathering, and monitoring of treatment
management through telehealth platforms. Wearable technology and IoT
devices can also monitor many health metrics in real time and relay
precise data back to a care setting. This continuous connectivity can
also give healthcare providers a more holistic view of patients'
faring. Ongoing connectivity means that interventions can be made
early before issues develop into crises and thus trip the flag for an
unplanned in-person clinic visit.
Advances in technological
functionality will continue to augment value-based care by making care
processes more efficient and effective. For example, advances in data
integration and interoperability will continue to reduce clinicians'
time copying and pasting electronic health records from one system to
another. Similarly, technological developments in user interface
design and mobile technology will continue to make care more
accessible and patient-centered as technologies become more intuitive
and easy for patients.
Consequently, custom software is one of the biggest enablers of value-based care as it offers customized tools tailored to the needs of both providers and patients. These tools allow for real-time data access, better patient supervision, and improved care coordination, which allows professionals to focus on providing high-quality patient-centered care. Custom software, therefore, aids the realization of value-based care goals and enhances management efficiency and cost-effectiveness, leading to better outcomes and satisfaction.