How Data Analytics Supports Success & ROI in VBC

Successfully implementing a value-based care (VBC) payment model can be complicated. It is particularly difficult for smaller or independent practices to do alone.

The traditional fee-for-service system has succeeded based on the quantity of services provided. However, in VBC, reimbursements and incentives are based on the quality of care provided.

Long-term data can be instrumental in revealing where practices can make improvements in order to have success in VBC. However, this information is frequently complex and unclear, creating obstacles for providers looking to enter into a risk-based contractual agreement.

Fortunately, practices can overcome these challenges. Having a strong partner that can analyze the data and determine how to leverage it can lead to better population health, higher quality of care, and more effective care management. As a result, practices implementing VBC can experience a greater return on investment (ROI).

VBC Is Growing

VBC is a less straightforward payment model than fee-for-service, but adoption is growing among providers. In fact, in 2020, more than 60% of payments received were linked to value. The Centers for Medicare & Medicaid Services (CMS) created accountable care organization (ACO) models to help even more providers transition to VBC reimbursement. The pivot toward VBC has been so significant that CMS set a goal for all Medicare recipients to be part of an ACO by 2030.

Providers looking to shift to a VBC model understand that data is king. But such a payment system will only work if practices know what to do with that information and how to leverage data to drive significant improvements. The same is true for succeeding with value-based contracts—agreements that focus on delivering the best patient outcome for the lowest possible price.

To gather this data, providers take several steps:

• 89% adopted data analytics and reporting software
• 59% added population health management systems
• 41% upgraded their electronic health records
• 38% upgraded registry platforms and patient portals

With this data, practices can boost ROI in several ways when participating in value-based contracts. They can:

• Track annual wellness visit and chronic condition codes to improve population health management
• Coordinate care with other providers to lower costs paid by Medicare, resulting in provider bonuses
• Improve patient care, as well as staff engagement and morale
• Boost patient engagement and expand patient access

However, managing the data to achieve this ROI isn’t always easy.

The Problem With Data

Despite being a vital component to VBC, data presents several significant hurdles. For example, when processing data to fulfill VBC requirements, providers can face these problems:

• Limited access: Data, for many providers, resembles Swiss cheese—there are significant holes due to inaccurate or incomplete databases. Without valid information about important factors like delivered services, patient comorbidities, or readmissions, VBC falters.
• Multiple payers: Providers work with a variety of payers, including Medicare, Medicaid, and commercial payers. Each payer must abide by different rules and restrictions. That means data may come in various formats. It can be aggregated or transaction based. Payers may also blind their data based on pricing or sensitive diagnoses.
• Large volume and lag: Depending on how many patients a provider serves, the amount of data collected can be massive. Then, providers must compare the data, select key points to examine, and identify any trends. In addition, there may be a claims lag in getting data back from different payers. These factors can create latency.
• Types of data: Payers may also provide different types of data, including full refreshes, incremental updates, or accounting-based claims that detail reversed or correctly paid claims. With this many data types, double counting can occur.

Providers already have enough to juggle every day. But even if they’re equipped to process all the data, it can be overwhelming and interfere with patient care. They may think they understand their data completely, but oftentimes there are too many challenges for all providers to handle it all the time.

Scaling Up with a Partner

Some practices may choose to tackle data analytics on their own. But collaborating with a partner who can focus on the insights can set providers up for not only better patient care, but greater ROI as they adopt the VBC model.

The challenge for any particular office is the heavy investment needed to deal with growing a cohort or population, person by person, within a practice. For many practices, that can be a scalability problem. Allowing a partner to manage all that data at a larger scale gives the office a way to manage and grow their business effectively.

There are several benefits to working with a business intelligence partner:

• Data analysis: A partner can examine practice data over time, calling out which metrics to assess regularly. This type of evaluation reveals opportunities for performance improvement and added value. For example, a partner may detect emergency room overutilization and suggest intervention.
• Care, quality, and management programs: Through established programs, such as “Call Your Physician First” or telehealth initiatives, partners offer providers interventions that increase efficiency, boost patient outcomes, and control healthcare costs.
• Contract negotiations: In many cases, providers or practices must apply to be included in new models or the launch of new contracts with payers. A partner can analyze the data sets needed to negotiate acceptable contract terms effectively. Additionally, they can identify opportunities for high-performing providers and pull together the best team of providers when creating a network.
• Managing mandates: CMS frequently issues VBC rules that carry new requirements—particularly technology mandates. Keeping up with regulations and timeframes is a heavy burden for providers. A partner can help individual and independent providers stay compliant.

With a partner, practices can focus on the patients, not the data, and they stay compliant with their contractual relationships with payers. They can realize a return on investment and focus on patient outcomes because someone else is helping to interpret the data.

The Bottom Line

When done correctly, implementing a VBC model fosters a more patient-focused, collaborative environment. Practices can shift away from the existing heavy workloads typically found in fee-for-service systems. And by working with a business intelligence partner to properly use and analyze data, the transition to VBC becomes less cumbersome for providers so that instead, they can concentrate on their top priority: delivering quality care that offers more value to both patients and providers.