With the healthcare industry, the ongoing transition from volume-based to value-based care and reimbursement it is having a profound impact on every area of the healthcare ecosystem. And while imaging and imaging informatics has traditionally been siloed from other areas of healthcare, among radiologists and imaging professionals, it is well understood that the movement from volume-based to value-based imaging is already underway.
During a webinar sponsored by the Society for Imaging Informatics in Medicine (SIIM), Rasu Shrestha, M.D., chief innovation officer at UPMC, the 39-hospital integrated health system based in Pittsburgh, laid out what was at stake for the imaging industry within the context of the move to value-based care and provided some context on where the imaging industry currently stands, and where it needs to go. The full webinar can be accessed here.
“How do we get to value-based imaging? It’s important as an industry to figure out what value really is, and how we use the power of data to measure that value and incentivize these value-based paradigms to be rewarded for the value that we are providing, and use it as our North Star,” Shrestha, who is also the executive vice president of UPMC Enterprises, its technology development arm, said during the presentation.
Radiologists face a number of challenges in moving to value-based imaging, such as the need to understand machine learning, aligning payers, providers and vendor partners, capturing the appropriate data to measure value as well as culture change. “Having radiologists become a part of the care team—this is what needs to be done to march towards value-based care,” he said. “We need to do this so imaging doesn’t become commoditized or marginalized and, instead, is a core component and a value-contributor in the rest of the health ecosystem.”
While there have been groundbreaking innovations in imaging since the first X-ray was discovered in 1895—the development of PACS (picture archiving and communication systems) workstations and the move from film to digital—there has not been as much of a cultural paradigm shift, according to Shrestha. “We’re still viewing images as opposed to looking at the patient as a whole. We’re doing it more efficiently and we’re reading more studies, but does an improvement in productivity quantify value? And, is that the whole story? My argument is that it is not,” he said.
Moving forward, provider organizations and imaging centers need to work more cohesively with payer organizations to look at the shift to value as risk moves from payers to provider organizations and then consumers.
He also asserted that radiologists and imaging leaders need to examine their role in the value-based care world. “Radiologists and imagers, we get relegated to being diagnosticians, and that’s where we are today. We’re not so much image consultants, which is what we need to be in this new world of value-based imaging. As we look at the specifics of how we need to accelerate and provide value across the board, what we’ve realized is that health care reform is here to stay. Despite some of the uncertainty that is part of the climate today around policy, healthcare reform is here to stay,” he said.
What’s more, health system reform also presents opportunities, he said, as it pushes the industry forward into value-based imaging, where there needs to be “a core focus on quality, outcomes and satisfaction, and we need to be accountable for the care we’re providing to patients.”
This shift to value-based imaging requires new metrics, Shrestha said, noting that radiologists today are measured by volume-based metrics, such as report turnaround time and number of studies read. Value-based imaging metrics should be based on superior outcomes, providing the level of increased transparency to understand where value is being generated, care coordination as well as utilization management and appropriateness.
Value-based imaging supported by IT
Radiologists need to transition to a patient-centric view of imaging, he noted, and then adopt newer care models and embrace new technologies and capabilities that are available to help support this patient-centric view of imaging. “Today, we are data rich and information poor. We as imagers are more detectives than diagnosticians. We have a lot of data on hand. Besides big data, there are other types of data elements, including data coming from electronic health records (EHRs), and soon other data elements coming in from outside the hospital system,” he said referring to patient-generated data.
Delving into the buzz around machine learning and artificial intelligence (AI), Shrestha noted that the “future ahead could look nothing like the past we left behind.” “With machine learning, we can leverage the power of all this data and it can give us insight we’ve never had before. So, the idea here is how do we leverage the power of those insights to quantify the value that we’re providing across the care continuum, and use that as an incentive for us in the radiology department, for us as an ecosystem of care providers, as we look at shared savings and shared risk, and use that to drive forward this mandate around value-based imaging.”