The need to shift from a fee-for-service model to value-based care (VBC) is clear. While 92 percent of payers and 81 percent of providers have seen increases in VBC contracts over the past year, execution is lagging, making it challenging to transform care. One of the biggest difficulties is data management.
Most organizations still rely on lagging, fragmented information to manage real-time clinical and financial risk, and that gap is becoming impossible to ignore. Only 53 percent of payers felt confident in the completeness and accuracy of the data used in VBC initiatives and 45 percent reported significant data issues due to fragmentation and optimization.
Payers and providers aren’t short on data; they are short on data that’s decision-ready. When claims files are delayed, electronic health record (EHR) data is incomplete, or social determinants of health (SDoH) indicators are not included in the core clinical record, this leaves providers struggling to manage outcomes in the rearview mirror.
“One of the biggest limitations is the timeliness of the data,” says Amanda Banister, senior manager of provider performance and tech utilization at Veradigm. “For a provider to react effectively, the data has to tell a meaningful story that enables action. Historical data is important, but it needs to include key details—such as dates, diagnosis codes, and information about the providers delivering care—to give full context. It’s hard to respond to things that happened months ago without that clarity, because a patient’s situation can change over time.”
Under value-based arrangements, where success depends on preventing complications rather than reacting to them, those blind spots can directly affect both care quality and financial performance.
Moving from hindsight to insight
Decision-ready data connects disparate streams of data to close gaps in care. Making multiple data streams, including clinical, claims, pharmacy, lab, and SDoH data, accessible in a single, near-real-time view that can identify risk, helps enable timely clinical action and shifts clinical decision-making from reactive to proactive.
“Providers are expected to be coding experts, documentation experts, and data experts when what they really want to do is take care of their patients,” Banister says. “Health plans have had to identify ways to get the information the provider needs to provide the best care…and products like Veradigm’s risk, quality, and health equity solutions make it possible to differentiate the noise from the value and delivers those gaps to the provider at the point of care.”
Having interoperable, actionable data enables providers to identify the highest-risk members before conditions escalate, which can reduce preventable costs downstream, including those associated with hospitalizations, complications, and member churn. Interoperability can also help health plans achieve higher HEDIS scores and Star Ratings, which in turn translate to revenue gains.
But technology alone won’t solve the integration problem. Providers vary widely in digital maturity, and layering on new systems can add friction rather than remove it.
“You have to meet providers wherever they are,” Banister says. “If you don’t, you’re just creating another disparate system on top of the ones that already exist.”
The American Medical Association identified five best practices for data-sharing in VBC:
- Create an interoperable data ecosystem that simplifies and expands data sharing
- Share more complete, comprehensive data to empower VBC
- Improve data collection and use to identify and address health disparities and barriers to care
- Share timely, relevant, and actionable data early and often to improve care
- Share data methodologies, calculations, and context to foster trust and improve performance
Veradigm Payer Insights (VPI) was designed to display care gap alerts directly within the EHR at the point of care when patients and providers are face to face. This enables timely, actionable interventions at the moment they’re most impactful, enhancing outcomes and satisfaction for both providers and patients, reducing costs, and improving overall efficiency. Banister calls it a tool that segments the data that is most meaningful and easiest to respond to, making it possible to deliver actionable and impactful care.
“Disparate systems aren't serving the provider or the patient,” she adds. “Being able to collect all that information and have it automated and delivered at the point of care in as close to real time as we can get. Veradigm is doing just that: supporting value-based care with our latest solutions like Veradigm Payer Insights.”
Decision-ready data may not solve every challenge in the shift from volume to value, but it addresses one of the most persistent ones: the time lag between insight and intervention, allowing providers to improve patient outcomes and achieve measurable returns on investment.
Contact us today to learn more about how Veradigm can support your shift to value-based healthcare
