How big a challenge is value-based care?

Healthcare providers are focusing on the transition from fee-based to value-base care, with its emphasis on quality and cost containment. But what does the move mean for chief information officers and others charged with building and maintaining the platforms that will support the new reimbursement model? Warren Whitford is research director, healthcare consulting and value-based care, at KLAS. He recently spoke with HDM contributor Bob Violino about the CIO’s role in value-based care. This is an edited version of that interview.

Is VBC one of the bigger hurdles hospitals will face?

It’s probably in the top five, along with security, cloud technology, EMR [electronic medical records] optimization, interoperability and healthcare analytics. A combination of government policy and market-driven incentives is converging to establish provider-driven value in the marketplace. Based on the interviews we’ve had with hospital executives, I would say that the transition from fee-for-service to value-based arrangements is certainly something most provider organizations are actively working on.

What is the role of the CIO as healthcare providers transition to value-based care?

Success in a value-based world requires more than just being good at population health. Health systems also need to capture enough of the value they’re creating in order to grow, and not cannibalize, their enterprise. So the natural question would be: How does a health system capture that value and how much is it going to cost? CIOs should ask themselves, how can I help my health system capture more value in these three areas:

• Organizational alignment: Addressing the mix, scale, and distribution of resources across the care continuum.

• Care management: Building population health capabilities, clinical protocols and patient-centered care models to improve delivery, quality and value of care.

• Reimbursement management: Optimizing cost structures, resource utilization, partnerships, and care capacity to capture maximum value from alternative payment models.

What will be CIOs’ biggest VBC challenge?

Payer and provider organizations have generally made extensive investments in both operational and analytical information technologies in recent years. Many of these systems are capable of sending documents and data to one another, yet very few are delivering on the need to bring together and share the full complement of health information required for collaboration and engagement, much less doing so in a timely fashion compatible with care management workflows.

This may be a challenge bigger than any one CIO can solve, but it certainly is the biggest IT challenge CIOs are facing. With that said, solving this issue will likely be the key to success in a risk-based contracting environment.