The shift from fee-for-service to pay-for-performance: Ep 19, HealthcareTalks

Medical Technology, Healthcare & Government IT

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Something that all CEOs and CFOs are looking at a lot these days is what is happening with the Affordable Care Act and things like accountable care, patient centered medical homes where there’s a big shift going from fee for service for seeing patients in volume, uh, volume care business, to a value care business. And in that world, uh, the data requirements — again, we mentioned, uh, um, that uh, data is, uh, is an important asset. This now plays an even bigger role.

You can actually get away with in the — in the modern fee for service world, you can get away with, uh, not necessarily having your data instantly accessible, always available through backups, archiving, et cetera, um, and go to paper whenever you need it because when a single patient comes in, you can generally find those records. But in the new world of accountable care and value driven care, all that value comes from a reduction in cost over time, which means data means everything. If you don’t have access to the data instantly, uh, when patients are coming, how you’re going to move them through your system, how they’re going — how you’re going to protect the fact that they can use all the services within your network of capabilities, then you actually will lose money in these scenarios, and that’s not what your CEO or CFO wants to hear is, “Hey, we would have made money, except, uh, we seem to have lost this piece of data,” or, “We don’t know where that piece of data is.”

But that’s a common story today. Not everybody knows where all of their data is, so you really need to make sure that you have a comprehensive approach. Bring someone in to help you understand where are all my sources of data, how do they move between the workflows, how do they get from system to system so that when I need it for my audits for accountable care or for my quality audits to be able to submit to, uh, the quality folks, um, how I’m going to do shared savings models. All of this becomes really important, and gone are the days when you can just say, “Oh, I can always flip back the paper when I need to,” because there is no paper to flip back to. These kind of data don’t exist on paper because they’re aggregates, they’re summaries, they’re analyzing, they’re analysis, they’re outcomes of reports which don’t exist on paper.

Uh, so this move from volume to value puts even more importance and impetus on making sure the data — you understand where it’s coming from, how you’re managing it throughout the entire information life cycle.

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