By Mike Burgin, Senior Vice President, Product
Overly complex quality measures, inadequate access to patient data, and a lack of tools to help collect and assess that data are the reasons many physicians continue to struggle with adoption of value-based care, according to a new study that Inovalon published earlier this month in collaboration with Quest Diagnostics.
Although the Healthcare Effectiveness Data and Information Set (HEDIS) quality reporting season wrapped up earlier this summer, health plans are now reflecting on the challenges they faced this year and looking ahead to next year’s reporting season. In an era where value and quality play an ever increasing role in care delivery, physicians and health plan executives are increasingly focused on the adoption of value-based care models and devising plans for how to overcome anticipated obstacles.
Quality Measures are Too Complex
According to the study, which captured responses from 300 primary care private practice physicians and 150 health plan executives, a majority (74 percent) of survey respondents feel that the multiple quality scoring systems, risk adjustment models, reimbursement rules, and myriad incentive programs result in overly complicated and complex quality measures. The complexity of these quality measures makes them difficult to assess adequately and therefore challenging to achieve.
Meanwhile, 64 percent of physicians surveyed said they are not equipped with accurate or sufficient patient data to truly provide value-based care. This hampered access to patient data creates a chasm between what physicians and patients are experiencing during an assessment and how that encounter is documented, leaving physicians with care gaps and incomplete pictures of patients’ health.
Technology and Tools Offer a Way Forward
Despite challenges to the adoption of value-based care, the movement is not without progress; physicians simply need the right platforms to help them succeed. For example, 64 percent percent of respondents reported that they lack the tools to excel in a value-based care system. Furthermore, 85 percent of physicians surveyed said they would be “likely or very likely to use a tool that provides on-demand patient-specific data to identify gaps in quality, risk and utilization.”
Technology that eases or improves quality measure adherence and risk score accuracy can be a powerful incentive to the adoption of value-based care. In addition, tools that offer point-of-care data analytics can prove tremendously valuable as physicians seek to better understand and identify which quality measures apply to individual patients.
Preparation for MACRA Begins Now
With the reporting period for the Medicare Access and CHIP Reauthorization Act (MACRA) slated to begin in January (although pressure from physician and healthcare groups may push the start date), it’s clear that physicians and health plans could benefit from tools designed to streamline and improve the measurement process. Data-driven technology platforms with actionable insights may provide just the springboard needed to overcome current obstacles for many providers and healthcare executives.
The complexity and sheer number of quality measures is certainly a challenge, but there are solutions to transition to value-based care with ease.