Why payer-provider collaboration is paramount in value-based care
DistilNFO had an opportunity to interview Garri L. Garrison, RN, Vice President of Performance Management at 3M Health Information Systems, a business of 3M Company. Garri is regarded as a thought leader in the healthcare industry having extensive experience in performance improvement, quality outcomes analysis, clinical documentation improvement programs & software development.
Payers & providers face many challenges as the healthcare industry transitions to value-based reimbursement. One of the biggest challenges is that providers, many of whom have only begun to tap into the power of big data, still operate in a largely fee-for-service world. They’re not accustomed to using data to improve the efficiency of care delivery, or using data to improve value via better outcomes or improve access to care. Nor do they have access to the breadth of data they need to drive change. This raises the question of whether payers are willing to share data with providers to help them gain improvements in quality & reduce costs.
1. Garri, thank you for taking time out of your busy schedule to talk with us. DistilNFO appreciates it. To start with, tell us a little bit about yourself and your journey at 3M HIS. Also, share with our readers the most exciting recent development at 3M HIS.
Garri: Before joining 3M, I was as a critical care nurse at several acute care hospitals over many years. As a nurse, I managed quality and performed care management, and I also learned to code. This clinical background and perspective has been such an important foundation for my work at 3M on reimbursement, quality, cost reduction, coding, and clinical documentation improvement. I also lead our performance improvement teams and have directed development of many new software products, payment solutions, and consulting services that will be relevant in today’s fee for service world and in a value-based care world.
We have a number of exciting initiatives underway, but I’d have to point to our joint technology development with Verily (formerly Google’s Life Sciences division). We’re working together to create new population health measurement tools that will merge and analyze clinical and claims data to drive dramatic insights into population health for both payers and providers.
2. With the change in administration, there’s uncertainty on the future of the ACA. How can healthcare executives and payers prepare for what may lie ahead?
Garri: As of today, we don’t know which of the key components of the Affordable Care Act will be repealed or replaced, so until there is resolution on federal mandates and funding, we’ll continue to see significant uncertainty in the market. Regardless of the direction, removing cost and improving quality will stay at the forefront of all changes. Also, keep in mind that MACRA passed in 2015 with tremendous bipartisan support and is likely to withstand any changes to the ACA.
3. Value-based care (VBC) has been a driving force behind many changes in the healthcare industry. What payer/providers trends are you starting to see emerge because of these changes?
Garri: One trend that has emerged with value-based care is provider-owned health plans. These entities are also known as provider-sponsored plans or provider-affiliated plans. Regardless of the terminology, the goal is the same: Reduce healthcare costs and improve outcomes. Provider-owned health plans can be successful because they’re able to channel patients to their own physicians and facilities, controlling as much of the healthcare dollar as possible. They also have the advantage of having complete longitudinal claims data for their enrolled population— something most providers cannot access for analytics, but a health plan can. As a result, provider-owned health plans are able to manage population health by using integrated information technology and analytics.
4. In VBC, how can payers and providers accelerate value and reduce costs?
Garri: The most effective way to accelerate value and reduce costs is to foster collaboration between payers and providers. Payers should share as much data as possible with providers and invest in the data infrastructure needed to give providers point-of-care access to information. Payers must also invest in tools that are proven to lower medical and administrative costs and enhance quality of care—and then share these tools with providers. Examples include tools that stratify clinical risk and analyze pathways of care, allowing care management teams to focus on the critical few. Other examples include interactive dashboards and reports to enrich and analyze healthcare data. Likewise, providers must be willing to make a concerted effort to improve data quality and incorporate administrative claims data and other types of data from payers into their daily workflow. This includes data about access patterns or data about patients whose disease progression varies from the norm.
5. Payers and providers are dealing with an unprecedented amount of data, making it critical to identify and prioritize the most meaningful data investments. Do you have any advice on how payers and providers can do this?
Garri: I agree that healthcare data is more complex—and this complexity is compounded by the volume of data, which is greater than ever before. More data isn’t necessarily a good thing when the quality of that data is poor or the data is simply irrelevant to the business need at hand. In terms of making the most meaningful data investments, payers and providers must identify where they can have the most significant impact and prioritize their focus areas accordingly. Otherwise, it’s easy to become overwhelmed.
On the provider side, healthcare organizations must determine whether the data they collect has a purpose—that is, whether it will help them meet a goal, answer a question, improve a process, or address another need. Providers can use data to drive internal activities that are correlated to strategic objectives (e.g., identifying potentially preventable events such as hospital readmissions or identifying the likelihood of readmission based on a patient’s condition and demographic details). The data can pinpoint the ‘who, what, where, when, and why’ of the data—that is, the big picture of how an organization intends to use it.
Data must be uniformly risk-adjusted to account for patient severity and risk of avoidable care. 3M has developed categorical classification models as an alternative to regression models because researchers can apply them uniformly and fairly across patient populations. In fact, many states have adopted our classification methodologies for analyzing and reporting hospital data and to design new Medicaid payment models, which can also be used by commercial plans.
Finally, we need to give more thought to data that goes beyond the clinical components of care. Some effort has been applied at the local level, for example, to the collection and use of social determinants in the management of patients, but there isn’t a common standard for collecting and using social determinants in reporting, research, analytics, or payment.
6. What strategies can you provide to help payers and providers derive greater insights from the data they collect?
Garri: The most effective way to derive insights is to ensure that the data is of the highest quality possible. This includes complying with coding and data submission guidelines as well as completing health risk assessments that capture social determinants. Poor quality data is data that’s incomplete, inaccurate, contains duplicate information, or has formatting inconsistencies. High-quality data requires an organization-wide commitment to data integrity
7. What’s your opinion on patient-generated data? Is this data clinically relevant, and can payers and providers use it?
Garri: To be clinically-relevant, patient-generated data requires analysis, and it must be presented at the point of care in a way that’s useful to providers. Providers shouldn’t be required to review every data point. Instead, they should be able to distinguish between the signal and the noise, receiving alerts only when data anomalies occur. For example, there are inhalers that measure usage. A provider could receive an alert when a patient starts to over-use the inhaler. The overuse could signal a worsening condition.
8. What solutions does 3M offer to payers and providers to enhance VBC?
Garri: 3M Health Information Systems offers patient classification systems and risk adjustment software that have become the industry standard for population health management. These classification systems align actual resource usage with clinical risk, allowing payers and providers to make the most of their data.
We work with payers to develop and track the progress of value-based programs that help physician practices and ACOs identify and address variation in healthcare costs and quality. By using the 3M℠ Informed Analytics business intelligence platform and consulting services, payers can identify the best opportunities for reducing costs and improving quality through predictive analytics and shared savings programs. 3M℠ Program Design and Performance Management assists payers with implementing programs, developing budgets, issuing settlement reports, and evaluating program outcomes.
On the provider side, we offer a provider analytics platform that augments hospital claims data to assess population health, physician performance, total cost of care, and other key measures, including competitor performance. We’re also known for a variety of solutions that enhance clinical documentation, which is the foundation for healthcare data quality. Our flagship product, the 3M™ 360 Encompass™ System, combines computer-assisted coding, clinical documentation improvement, and quality metrics and analytics into a single application. The system offers reporting, dashboards, and quality indicators for a true and real-time reflection of care. It also identifies key patient safety indicators while the patient is still in the hospital.
9. Can you share an example of how a payer worked with 3M to enhance VBC?
Garri: 3M partners with payers nationwide to help them translate data into actionable information. Currently, we generate population health analytics for 55 million lives in Medicaid, Medicare, and commercial populations. For 10 million of these lives, we directly participate in the design and measurement of Value-based Purchasing arrangements. One recent example is a payer in the southeastern United States that saved more than $30 million that was shared with providers in the second year of its Accountable Care Organization (ACO) program. 3M attributed these results to targeted data sharing via its 3M dashboards that provided the ACO and its participating providers with insight into financial and quality performance.
3M has also partnered with this same payer to create and refine its VBC programs through strategic consultation and using our enhanced data assets. The payer willingly shared data with its providers to help them reduce costs and improve outcomes and share the savings—one of the many reasons why the ACO has been so successful.
Payers and Providers are encouraged to check out a wide-range of information, services, resources, blogs and videos on the 3M Health Information Systems website.
10. Any closing thoughts you’d like to share with our readers?
Garri: Yes. Payers and providers must no longer be adversaries. Instead, they must work together and ensure data transparency. That’s the only way to move forward in this new era of VBC. A willingness to share data with mutual goals brings benefits for both payers and providers. This data sharing also ultimately improves care and benefits patients directly.
Source: DistilNFO