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4 Challenges of Transitioning to a Value-Based Integrated Health System

Electronic health recordsBecause value-based payment forges a new kind of integrated health system based on the interdependence of financial compensation, quality of patient care and provider performance, it presents a whole new set of challenges to the healthcare industry. Ideally, these challenges will be identified and resolved before they occur so unforeseen issues can be addressed as promptly as they appear.

While the challenges of transitioning to value-based payments are many, some must be given priority to ensure that the integrated health system can properly function. Debriefed below, these challenges are: effectively reorienting physician workflow, prioritizing the needs of high-risk patients, resisting overdependence on electronic health records and ensuring information accuracy.

1. Effectively reorienting physician workflow

Studies show that almost 50% of physicians experience symptoms associated with burnout. In the volume-based, fee-for-service healthcare system that rewarded providers for seeing a greater number of patients, this danger was at a greater risk of being intensified by the very structure of the profession. Occupational hazards like burnout are much less likely to occur in an integrated health system that rewards providers for quality care and healthy patients. However, adjusting to such a system will be a challenge for doctors who are used to measuring their success in volume. Providing physicians with assistance to make this adjustment and easily transition to this new value-based integrated health system will be essential to its success. They will need to be provided with many new examples and models of goal-setting to assist them off the fee-for-service “hamster wheel.”

2. Prioritizing the needs of high-risk patients

Implementing a value-based payment system could be all for naught if high-risk patients are not afforded appropriate quality care. 20% of everything we spend on healthcare goes to just 1% of all patients, so assuring that these patients maintain good health is essential to a value-based integrated health system. If these patients are not afforded the disproportionate amount of resources that they require, healthcare spending could actually increase in the company of lacking quality patient care.

3. Resisting overdependence on electronic health records

Electronic health records (EHRs) are revolutionizing continuity of care in the new integrated health system, dramatically reducing the amount of wasted hospital resources. Specifically, reducing the amount of paperwork associated with each patient reduces the possibility for miscommunication and misinformation, which becomes more problematic in an integrated health system that has more cooks in the kitchen. Unfortunately the patient population that has the most to gain from EHR integration is the demographic that is least likely to adopt it: post-acute care. Thanks to the exclusion of post-acute care facilities from EHR financial incentives, many post-acute care facilities won’t have the resources or motivation to advance to using EHRs. Thus, an over-reliance on EHRs in an acute care setting could leave post-acute care facilities and patients seriously lacking the information they need to provide quality patient care and prevent hospital readmissions.

4. Ensuring information accuracy

Value-based, integrated health systems are built on a foundation of Big Data coming from EHRs and quality performance measures. The complex data sets pulled from this information are used to define quality and make healthcare decisions based on patient trends. Quality measures are necessary, but only if there is assured accuracy of the information being measured. A meaningful, appropriate program should be developed that sets clear standards to be understood and met by each constituent in the integrated health system. It should also confirm the accuracy of all healthcare information so that it is compatible and reliable. Establishing a sophisticated standardization and regulation of data is critical in order for the system to function. Developing compliance measures will be an essential part of ensuring information accuracy and standardization.

The interdependence created by a value-based integrated health system will benefit the entire population as well as the healthcare industry, but only if its risks and problems are thoroughly teased out and addressed. A small snag—particularly in the realm of information accuracy—could mean big problems for value-based payments. It will be best to proceed with mindfulness and caution as we make advancements in national healthcare.

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