Value-Based Care Transformation via FHIR

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Value-Based Care Transformation via FHIR
Value-Based Care Transformation via FHIR

About Ankit Agarwal: Ankit is a Wharton graduate and is currently working as “Director of IT” with NewWave Telecom and Technologies Inc. Ankit has extensive experience in solving complex healthcare IT problems, and he is passionate about bringing impactful changes into people’s lives. Ankit has a YouTube channel to discuss the latest healthcare trends and writes blogs to educate people and promote digital health.

FHIR can help support the goals of value-based care by enabling the efficient sharing of information, promoting interoperability, and supporting data-driven decision-making.

This is an exclusive interview conducted by the Editor Team of CIO News with Ankit Agarwal, Director – IT Delivery Services at NewWave Telecom & Technologies Inc.

What is value-based care?

Value-based care is a healthcare delivery model in which providers are paid based on the quality and outcomes of the care they provide, rather than the number of services or procedures they perform. This approach aims to improve the overall health of patients and reduce costs by encouraging providers to focus on preventive care and coordinated, patient-centered care. Examples of value-based care models include accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

What are the challenges with value-based care?

There are several challenges associated with implementing and maintaining a value-based care model:

  • Data collection and analysis: In order to measure the quality and outcomes of care, providers must have access to comprehensive, accurate patient data. This can be difficult to collect and analyze, especially for smaller practices or those that lack electronic health records (EHRs).
  • Alignment of incentives: In a value-based care model, the incentives of providers and payers (e.g., insurance companies) may not be aligned. Providers may be focused on providing high-quality care, while payers may be focused on controlling costs.
  • Coordination of care: In a value-based care model, coordination of care is critical to achieving positive outcomes. However, this can be difficult to achieve in practice, particularly in systems with multiple providers and payers.
  • Risk sharing: Many value-based care models involve some form of risk sharing, where providers are financially responsible for the cost of care. This can be challenging for providers, particularly those that serve a high-risk patient population.
  • Quality measurement: In value-based care, quality is measured by different indicators, not only by procedures or services provided. Identifying and measuring the right quality indicators can be a challenge.
  • Funding: Implementing value-based care models can be expensive, and there may be a lack of funding to support the necessary infrastructure and technology.
  • Resistance to change: Many providers may be resistant to change and may be hesitant to adopt new care models, particularly if they are not familiar with them.

How can FHIR help transform value-based care?

FHIR (Fast Healthcare Interoperability Resources) is a set of standards for exchanging electronic health information between different systems and organizations. It can help with value-based care in several ways:

  • Data sharing: FHIR enables the sharing of patient data across different systems and organizations, which is critical for coordinating care and measuring outcomes in a value-based care model.
  • Interoperability: FHIR promotes interoperability, allowing different systems and applications to work together seamlessly. This can help with care coordination and the efficient sharing of information between providers and payers.
  • Data standardization: FHIR provides a common set of data elements and standards that can be used across different systems, making it easier to collect, analyze, and report on patient data.
  • Access to patient data: FHIR enables providers to access patient data from a variety of sources, such as hospitals, clinics, and home-based monitoring systems. This can help providers make more informed decisions about care and improve outcomes.
  • Cost reduction: FHIR helps to reduce costs by providing a common language for data exchange, reducing the need for costly custom integrations and data mapping.
  • Analytics: FHIR data can be used to run analytics and population health management, which can help identify patterns, trends, and areas for improvement in care delivery.
  • Quality measurement: FHIR can support the collection of data for quality measures, which are used to measure the performance of healthcare providers in value-based care models.

Overall, FHIR can help support the goals of value-based care by enabling the efficient sharing of information, promoting interoperability, and supporting data-driven decision-making.

Steps to Implement Value-Based Care via FHIR:

Here are some general steps that organizations may take to implement value-based care using FHIR:

  • Assess current systems and infrastructure: Organizations should assess their current systems and infrastructure to determine if they are capable of supporting FHIR and value-based care. This may include an assessment of existing EHRs, data analytics systems, and other technology.
  • Develop a data governance plan: Organizations should develop a data governance plan to ensure the secure and appropriate use of patient data in a value-based care model. This may include policies and procedures for data access, sharing, and storage.
  • Implement FHIR: Organizations should implement FHIR as the standard for exchanging electronic health information between systems and organizations. This may involve selecting a FHIR-enabled EHR or other software, as well as configuring and testing the system.
  • Develop and implement quality measures: Organizations should develop and implement quality measures to measure the performance of providers in a value-based care model. This may include selecting appropriate measures, collecting and reporting data, and analyzing the data to identify areas for improvement.
  • Create care coordination mechanisms: Organizations should create mechanisms for coordinating care between providers, including care teams and care pathways. This may involve developing protocols for communication and care management, as well as training providers on the use of these mechanisms.
  • Implement financial and risk-sharing models: Organizations should implement financial and risk-sharing models, such as accountable care organizations (ACOs) or patient-centered medical homes (PCMHs). This may involve developing contracts, agreements, and reimbursement models with payers and training providers on the use of these models.
  • Monitor and evaluate progress: Organizations should regularly monitor and evaluate progress in implementing value-based care and FHIR and make adjustments as necessary. This may include monitoring performance on quality measures, evaluating the effectiveness of care coordination mechanisms, and assessing the impact of financial and risk-sharing models.

It’s important to note that these steps are general guidance, and the implementation of value-based care using FHIR may vary depending on the specific organization and its needs.

“This article was peer reviewed by the CIO News editorial team prior to publication.”

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