Programs and services that address gaps in care through provider-payer data exchange via health information technologies can produce a high return on investment, according to a new report from the Workgroup for Electronic Data Exchange.
The WEDI report, titled “Closing Gaps in Care through Health Data Exchange,” reflects mixed-methods qualitative research performed by the Louis W. Sullivan Institute for Healthcare Innovation examining data exchange challenges and identifying effective strategies for workflow automation and optimization.
The 63-page report provides an overview of trends, best practices, opportunities and challenges related to the implementation of gaps in care programs. And the report addresses using health information technology to automate the identification and closing of gaps in care, or the discrepancy between evidence-based recommendations or best practices and the care that is actually delivered.
“Automated data exchange is critical to the successful coordination, delivery and payment of value-based healthcare. Interoperability remains a significant barrier to fully leveraging information technology to assist team-based care coordination across the continuum,” the report authors wrote.
For many providers, there continues to be wide gaps as they are unable to seamlessly access or share patient health information electronically with other organizations, the report states. “As a result, they are unable to efficiently identify patients in need of healthcare services or deliver services according to evidence-based guidelines in a timely manner. Not closing these gaps in care significantly affects the quality and cost of care by contributing to adverse patient outcomes and inappropriate care,” the report authors wrote.
WEDI offers six key findings from the report:
There needs to be greater education and communication to raise awareness among stakeholders, particularly providers, about the value of identifying and closing gaps in care. “Providers appear to lag behind health plans in implementing gaps in care programs. Challenges include the lack of sufficient resources or education about how to maximize workflow changes and effectively close gaps in care,” the authors wrote.
Gaps in care can threaten the performance of healthcare organizations. According to the authors, surveyed providers are significantly more concerned than health plans that gaps in care pose a threat to their organization by affecting clinical performance, financial performance and the ability to retain patients.
Gaps in care programs have had a positive impact and seem to produce a high return on investment. The authors concede that it may be premature for organizations to conclusively evaluate the impact of gaps in care services, however, improvements were observed in quality outcomes such as access to behavioral healthcare, pediatric and adolescent check-ups and medication adherence. “Reductions in utilization of ambulatory care, hospital admission and hospital readmissions were also observed. Compared with providers, health plans reported that gaps in care services had a more positive impact on domains such as patient compliance/adherence, patient satisfaction, care coordination and efficiency,” the authors wrote. And while gaps in care programs can incur high up-front costs, these programs also can yield high return on investment, particularly for health plans.
Consensus is needed to develop and standardize quality measures and methodologies for information exchange among health plans, providers and patients in an actionable manner. “The terminology, standardization and scope of gaps in care measures in care measures need more clear definition and alignment between health plans and providers before actionable data harmonization can occur,” the report authors wrote. In addition, providers would benefit from shared best practices that illustrate stakeholder roles, automation of workflow and quality improvement.
In addition to interoperability, key technical barriers to exchanging gaps in care information include the provenance, quality, completeness, timeliness, transparency and accuracy of data. “With so many systems and organizations designed around file-based exchange and feature functions of technology systems, greater efforts are needed to advance open APIs and element-based exchange that would allow more seamless transmission of data.
Addressing gaps in care is a critical issue for stakeholders that grows in importance as value-based care efforts mature and health insurance coverage access and care increase. “As we increasingly grow fee-for-value arrangements in our nation, it is critical that we look to methods to not only automate gaps-in-care—to not only ensure that data moves seamlessly between clinical systems and payment systems but that the information is useful and actionable for clinicians and patients,” Louis W. Sullivan, M.D., board chairman of the Sullivan Institute said in the report.
WEDI also offers a number of recommendations and collective action steps for the industry going forward. One recommendation is to develop a standard data dictionary for gaps in care. In collaboration with the WEDI and its multi-stakeholder base of member organizations, the Sullivan Institute will convene a workgroup to leverage existing efforts and activities from the field and provide a blueprint of the data elements required to identify, communicate and close gaps in care, according to the authors.
The report also recommends that industry stakeholders identify best practices for patients to leverage their own data and use technology to close gaps in care. “As organizations pilot use cases for element-based exchange, it will be critical to explore how more seamless data exchange can impact the patient experience of care across the continuum. The Sullivan Institute will convene the Patient Experience Council to examine how tri-directional data exchange will impact patients and, in addition, identify the structural and technical capabilities that providers, health plans and vendors must develop in order to adapt to the radical increase in structured clinical data that will come online,” the authors stated.
And, report calls for stakeholders to develop and align alternative payment models to support data measurement. The Sullivan Institute plans to convene stakeholders to identify how quality measurement initiatives can be better harmonized and how payment incentives can be delivered at a more granular level to encourage the data documentation and analytic activities required to launch successful gaps in care programs, the report states.
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