The Growing Importance of Data in Value-Based Care

Barry Chaiken, M.D., Chief Medical Information Officer at Infor, a New York City-based business application software vendor, recently offered up his perspective on the growing importance of clinical and administrative data during this era of change in the healthcare industry. Here’s what Chaiken had to say:

What is the biggest challenge facing healthcare organizations today?
The industry is moving away from volume-based reimbursement toward value-based reimbursement. As a result, healthcare organizations will now be reimbursed based on the quality of care provided, not just on the quantity. With this new paradigm in place, healthcare organizations need to provide high quality care in a cost effective manner. So, leaders really need to examine exactly what they are doing. Where you take care of patients, exactly how you take care of patients, what the outcomes are – all of those things become very important. 

What can organizations do to get a better handle on analyzing and improving their performance under value-based purchasing?
The only way for leaders to know if what they are doing is working is to have access to comprehensive data – both clinical and financial.

An effective data program, however, has to do two things. First, it has to focus squarely on the patient. The data cannot focus on the single episode of care or focus on the organization, but instead must focus on the patient – providing a holistic, complete view of the individual patient.

In addition, organizations must be able to apply analytics to the data in an effort to truly understand the care that they are providing.  Previously, much of the analytics was based on claims data – which was often two, three or four months old. That won’t work anymore. We now need to bring together current, relevant administrative and clinical data to seamlessly paint a picture of what is happening with the patient.

Why is it so important to integrate clinical and financial data?
It might be tempting to just say let’s deliver the highest quality care and not worry about costs. But there is a point where the extra spending really is not providing any value. You have to find that sweet spot where you are producing the optimal outcomes at the lowest cost. For example, when a patient has a knee or hip replacement, there is a certain amount of money that you need to spend to get them well.  But when you start overspending then you are just wasting money and the patient is not really experiencing better care. You need to find that very precise point where you are getting the best care for the money.

How can healthcare organizations determine where that sweet spot – where optimal care and the best value – exists?
The first thing leaders need to do is decide what optimal care is. You need to define it. What are the clinical, safety and financial outcomes that define optimal care? Then start measuring it. Are you producing the clinical, safety and financial outcomes that you defined?

To determine if you are succeeding, you have to be able to not only access but integrate the clinical outcomes and costs data. For example, if you are looking at cost data in a vacuum, you might always go with the least expensive hip replacement materials. But if you are looking at cost data that is integrated with clinical outcomes data, you might find that the more expensive hip replacement actually produces significantly better outcomes for the patient and more than pays for itself down the line.  For example, patients with the more expensive hip replacement might need less physical therapy – and the hip might last longer. So, going with the more expensive option is a wise financial decision in the long run.

For many years, integration of such data in healthcare has been a troublesome challenge – as the information typically resides in disparate systems. Infor, however, is able to pull the data together with our Cloverleaf Integration Suite, an enterprise-caliber integration platform that facilitates the movement of secure data through disparate systems within and outside the healthcare enterprise. Cloverleaf was developed exclusively for healthcare and, therefore, facilitates high-performance, high-capacity integration and information exchange.

In addition to data integration, healthcare organizations have also struggled with usability.  How is Infor ensuring that decision-makers can actually utilize data to make better decisions?
Data does not do much good – until decision makers can actually use it.  For example, it doesn’t do any good to show a nurse a bunch of data about congestive heart failure, if she cannot immediately use the data at the point of care. You have to deliver the right data in the right format to the right person. At Infor, we make sure that our software solutions deliver data in an easy to decipher format. We use colors, fonts and icons that truly engage the end-user.