Some 60% of health plans report they review gaps in care based on manual requests to providers. Only 9% of health plans can identify gaps in care in real time.*
Most organizations work through manual processes to improve quality measures and performance ratings. As a result, payers and providers report spending millions of dollars on tasks such as:
- Chasing supplemental data feeds
- Requesting extracts from the electronic medical record (EMR)
- Scrubbing patient charts
Provider organizations sometimes fail to deliver (and payers fail to receive) consistent and accurate clinical data captured through professional billing. As a result, they run the risk of diminished performance on various pay-for-performance incentive programs.
Ultimately, both payers and providers want to reduce unnecessary spending and inefficiencies and increase financial performance. To do so, they need to collaborate to eliminate discrepancies between care delivery and data capture.
The EMR is one tool they can use to create more efficient workflows for data capture. This enables providers to increase gap closure and decrease the volume of data discrepancy disputes.
How can existing technologies be optimized to support providers in closing care gaps and capturing all needed data? Organizations should consider creating a direct line of sight into current open gaps at the point of care. Then providers can take real-time action to close them.
There are several benefits to leveraging the EMR to close gaps in patient care. These include the following:
- The care team will be able to better manage the health outcomes of their patients. Providers can take preventive measures that may help better manage chronic conditions and increase the overall quality of life for their patients.
- The care team may be doing great work and providing quality care, but they may not be getting the appropriate credit for it. For example, there may be insufficient documentation and/or incorrect codes that are not being sent on a claim.
Understandably, this can create frustration for providers, payers and health systems. Providers don’t get credit for doing high-quality work. Payers don’t get accurate data. And health systems burn avoidable costs to fulfill payer requests for supplemental data. - Health systems will increase opportunities to improve patient engagement. Having clean and clear data available in real time gives providers a more accurate depiction of the patient’s full clinical picture. This allows the physician to have more comprehensive and efficient interactions with their patients.
- Executing and sustaining a top-notch quality program requires data and technology. Efforts such as education campaigns, trend analysis, coder reviews and opportunity reports might help improve performance.
But they fall short if they’re not informed by the right data at the right time and organized by information technology. Worse, providers might abandon them altogether if they prove to be too burdensome.
To that end, using sophisticated technology tools and expertise can help create a “less is more” approach to quality measures. Health systems can use standardized care coordination processes across the enterprise to deploy interventions based on skill mix.
This type of approach allows the already overburdened physician the opportunity to practice at top-of-license. It also maximizes the value for each patient visit.
The entire effort becomes more effective when best practices are integrated into existing patient evaluation, billing and documentation workflows using IT.
That said, many providers don’t have access to the assistive tools needed. Without the support (process and technology) needed to meet the requirements of various quality programs, providers will continue to struggle to manage this crucial component of value-based care.
*Workgroup for Electronic Data Interchange. Closing Gaps in Care through Health Data Exchange, 2016.
This article first appeared in Health Data Management.
