THE “MEANINGFUL USE” Electronic Health Record (EHR) Incentive Program successfully brought the vast majority of healthcare providers into the computer age and transitioned the industry from a paper-based world to a digital one. That much isn’t up
for dispute. What’s less certain is whether all the data generated
by these electronic systems is being used effectively to improve
patient care, drive down costs, and deliver value-based care.
While it’s still too soon to know whether the meaningful use
program and its successor, the Medicare Access and CHIP Reauthorization Act (MACRA), are succeeding in moving the country
away from fee-for-service and toward a reimbursement model
that rewards quality, there are some early signs of progress.
Melanie Meyer, PhD, RHIA, CPHQ, CCS, performance improvement leader at EVOSCALE Health in Redwood City, CA, pointed to
a recent survey from the Society of Actuaries (SOA) as one indication of EHR systems’ success with analytics and value-based care.
The SOA found that 60 percent of healthcare executives are using
predictive analytics within their organizations. Furthermore, 60
percent of payers and providers expect to invest 15 percent or more
of their spending on predictive analytics tools. 1 Predictive analytics
tools are a crucial part of helping providers meet the Quality Payment Program and Merit-based Incentive Program (MIPS) under
MACRA and advancing population health initiatives.
Meyer adds that organizations lucky enough to have integrated
EHRs—or those that hold an organization’s clinical and financial
data—are more successful with MIPS and similar efforts.
“Value-based care requires reporting and analysis based on
the integration of multiple types of data. EHRs that can do this
provide value,” Meyer says. “Having an EHR also provides the
foundation to do predictive analytics, and clinical-decision sup-
port—which also support value-based care.”
The success of accountable care organizations (ACOs), which
are based on a payment model that emphasizes technology and
shared risk to improve outcomes, has been mixed. Research by
Leavitt Partners found that 74 of Medicare’s 561 ACOs left the
program between 2018 and 2019. However, Aledade—a firm co-
founded by Farzad Mostashari, MD, former National Coordina-
tor for Health IT (ONC) under President Obama—recently re-
ported great success in helping its ACO partners reach key MIPS
“In performance year 2018, 80 percent of Aledade’s ACOs received perfect MIPS scores and every Aledade ACO with a 2017
score maintained or improved its quality scores from the prior
year. More than 70 percent of Aledade’s ACOs improved their
quality score by two percentage points or more,” the firm reported in a statement.
In a more tangible sign that value-based care is taking hold,
the state of North Carolina—which resisted the Affordable
Care Act’s Medicaid expansion—is now taking concrete steps
to move past fee-for-service care through several state-based
initiatives. North Carolina’s Department of Health and Human
Services, as well as Blue Cross and Blue Shield of North Caro-
lina, are starting to pay primary care providers higher rates on
preventive care services and care episodes that don’t involve
hospital stays, according to a report by the New York Times. The
state is also forming ACOs, using government funding to imple-
ment social determinants of health (SDOH) pilot programs, and
enacting a state-wide data-sharing network for referral services
and appointment reminders, the Times reported.
But much of the nitty gritty of carrying out value-based care
programs falls on health information management (HIM) pro-
fessionals. They’re the ones facilitating data requests from pay-
ers, incorporating analytics tools into EHRs, customizing EHR
workflows, nudging physicians to capture CCs and MCCs prop-
erly, pushing out care management messages to patient por-
tals, and keeping a constant eye on the rulemaking processes in
Washington, DC, that will impact their work.
Through their interaction with regulations, health information exchanges (HIEs), physicians, vendors, and IT and finance
departments, HIM holds the key to unlocking value-based care
and offering insight on how it’s progressing.
Smooth Sailing for Some
When it comes to deciding if all the investment in extensive
health IT systems and sophisticated analytics tools are worth it,
the truth it still sometimes in the eye of the beholder. Susan Hatem, MSM, RHIA, CRCR, HIM director for Wake Forest Baptist
Health in Winston-Salem, NC, works for an academic medical
center comprising five hospitals and more than 200 physician
clinics in the metropolitan area. Hatem says her system takes its
academic and teaching approach to medicine seriously—and
that means educating patients about their conditions as well as
the nurses and physicians in training. For Hatem, value-based
care entails entering value-based care contracts with private
insurers and ACOs, in addition to making sure patients get the
best possible information about themselves.
Accomplishing all of this was much more difficult in a paper-based world. For example, Hatem says a payer recently requested 20,000 records for review in a very short period of time—a
request that would’ve been nearly impossible to accommodate
before EHRs. Wake Forest’s EHR vendor was able to provide all
those records to the payer swiftly through a portal.
“Earlier in my career, pulling even 50 records for an audit was burdensome—now 50 charts is no problem. With all the stuff we review
charts for, EHRs have definitely been a godsend. The only thing I
worry about is that physicians get all this extraneous information
that’s scanned into the records and we get a lot of junk, for lack of
a better word,” Hatem says. “On the flip side, I think some of that is
good because we get more data on the patient because it’s easier to
put in there, and the more information you have, the better.”
Hatem says she’s currently seeing more audits and requests
for data than at any other point in her career—audits from payers, DRG reviews, payment integrity reviews—and being able to
pull the various data collections and collapse them into a PDF is
much easier with EHRs. Wake Forest also has a large population
health department that helps payers and physician offices with
“roster management,” which includes making phone calls and
pushing patient portal messages to patients who might be missing appointments or failing to schedule needed follow-up visits.
While there are still many benefits of having more data on any
given patient at any point in time, there’s an unavoidable human element in managing the care of populations.